Adult | www.visa-b1b2-migration-consultan.com

DS-160 preparation assistance form reviewed by a California Registered Immigration Consultant (Registration No. ACC006A001126)

Consultation Folio: DS160-US-558882-GN

Simplified Private Application Form for US Visa

For any question you don't know the answer to, you can leave it blank and the migration consultant will assist you with your form.

Personal Information 1

NOTE: Data on this page must match the information as it is written in your passport.

Select a location where you will be applying for this visa

Security Question

Answer

First name

Last name

Sex

Male

Female

Have you used other names (for example: maiden names, religious names, professional names, aliases, etc.)?

Yes

Help: Other names used may include, but are not limited to: Maiden name, Religious name, Professional name, or any other name by which you have been referred to or have been referred to in the past

Please provide the following information:

Birthday

Month

Day

Year

Country/Region of Origin (Nationality)

Do you hold or have you held any nationality other than the one indicated above on nationality?

Yes

Other Country/Region of Origin (Nationality)

Are you a permanent resident of a country/region other than your country/region of origin (nationality) indicated above?

Yes

Other Permanent Resident Country/Region

Personal Information 2

National identification number

If you don't have one, click on: Not applicable

Selection

Not applicable

U.S. Social Security Number

United States Social Security Number

If you don't have one, click on: Not Applicable

Selection

Not applicable

U.S Taxpayer ID Number

Help: Identification Numbers

If you do not have a National Identification Number,

a United States Social Security Number,

or a U.S. Taxpayer Identification Number, then write 'Not applicable'

Selection

Not applicable

Travel Information

Select the Visa

Have you made specific travel plans?

Yes

Travel Companions Information

Are there other persons traveling with you?

Yes

If I answer the previous question, please provide: The last name, first name, and relationship of the person I am traveling with, or the name of the group or organization, if applicable.

Previous U.S. Travel Information

If you have ever been to the United States, please provide information about your last five visits to the United States:

Have you ever been issued a U.S. Visa?

Yes

Date Last Visa Was Issued

Month

Day

Year

Visa Number

Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?

Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services?

Address and Phone Information

Home Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Primary Phone Number

Secondary Phone Number

Work Phone Number

Do you have a social media presence?

Social Media Identifier

Passport Information

Passport/Travel Document Type

Passport/Travel Document Number

Country/Authority that Issued Passport/Travel Document

Where was the Passport/Travel Document Issued?

City / State/Province/ Country

Issuance Date

Month

Day

Year

Expiration Date

Month

Day

Year

U.S. Point of Contact Information

Contact Person or Organization in the United States, This can be anyone who knows you and can verify your identity, if necessary. If you don't personally know anyone in the U.S., you can provide the name of the store, company, or organization you plan to

Relationship to You Click here for more information

U.S. Street Address (Line 1)

City/State/ZIP Code/

Phone

Family Information: Relatives

NOTE: Please provide the following information about your biological parents. If you are adopted, please provide the following information about your adoptive parents. If you do not know the information, leave the field blank.

Father's Full Name and Date of Birth

Surnames

Given Names

Date

Month

Day

Year

Mother's Full Name and Date of Birth

Surnames

Given Names

Date

Month

Day

Year

Do you have any immediate relatives, not including parents, in the United States?

Family Information:

NOTE: Enter current spouse information.

Surnames

Given Names

Birthdate

Month

Day

Year

Address

Country/Region of Origin (Nationality)

City

Country/Region

Present Work/Education/Training Information

NOTE: Provide the following information concerning your current employment or education.

Primary Occupation

Present Employer or School Name

Employer Address

Phone

Start Date

Month

Day

Year

Previous Work/Education/Training Information

Primary Occupation

Present Employer or School Name

Employer Address

Employment Date From

Month

Day

Year

Employment Termination Date

Month

Day

Year

Briefly describe your duties:

If you have attended any secondary or higher education institution, please add the name of the institution, postal address, country, curriculum, and entry and graduation dates.

Provide a List of Languages You Speak

If you have traveled to any country or region in the last five years, please provide the information.

Note: You have completed the data entry for review of your information by a Registered Migration Consultant. Before submitting, please review the information entered. To proceed with payment for the service, click the "pay" button at the bottom of the page. If any information is incorrect, you can return to make changes without affecting your form, as this is part of the service.

Attach your passport or take a photo

Attach your Visa or take a photo

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

I confirm that the information in this session corresponds to the device from which I am making this request and authorize its registration as part of the electronic file for my application.

I understand and accept that the IP address, browser information, operating system, device type, session identifiers, date, and time may be used to verify the authenticity of this request, prevent fraud, resolve payment disputes, and comply with legal obligations.

I have read and agree to the Terms of Use, Privacy Policy, and Refund Policy.