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

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Consultation Folio: DS160-US-509011-EI

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

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

Sex
Male
Female
Marital Status
Country of Birth
Country/Region of Origin (Nationality)
Do you possess or have you ever possessed any nationality other than the one indicated above in the nationality section?

Personal Information 2

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

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

Selection
Not applicable

United States Social Security Number

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

Selection
Not applicable

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

Purpose of Trip to the U.S
Have you made specific travel plans?
Yes
No
Have you made specific travel plans?
Provide a complete itinerary for your travel to the U.S.:
Month
Day
Year

If you are unsure of your travel plans, please provide an estimate.

Intended Length of Stay in U.S. Click here for more information
Person/Entity Paying for Your Trip
Relationship to You Click here for more information
Is the address of the party paying for your trip the same as your Home or Mailing Address?

Travel Companions Information

Persons traveling with you
Are you traveling as part of a group or organization?
Relationship with Person Click here for more information

Previous U.S. Travel Information

Have you ever been in the U.S.?
Date
Month
Day
Year
Intended Length of Stay in U.S. Click here for more information
Do you or did you ever hold a U.S. Driver’s License?
State of Driver's License
Have you ever been issued a U.S. Visa?
Date Last Visa Was Issued
Month
Day
Year
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
Do you have a social media presence?

Passport Information

Passport/Travel Document Type
Country/Authority that Issued Passport/Travel Document

City / State/Province/ Country

Issuance Date
Month
Day
Year
Expiration Date
Month
Day
Year
Have you ever lost a passport or had one stolen?

U.S. Point of Contact Information

Provide the following information:

Country/Authority that Issued Passport/Travel Document

Contact Person or Organization in the United States

Your U.S. Point of Contact can be any individual in the U.S. who knows you and can verify, if necessary, your identity. If you do not personally know anyone in the U.S., you may enter the name of the store, company, or organization you plan to visit during your trip.

Relationship to You Click here for more information

City/State/ZIP Code/

Family Information: Relatives

Father's Full Name and Date of Birth

Date
Month
Day
Year
Is your father in the U.S.?

Mother's Full Name and Date of Birth

Date
Month
Day
Year
Do you have any other relatives in the United States?
Do you have any immediate relatives, not including parents, in the United States?
Is your mother in the U.S.?

Family Information:

NOTE: Enter current spouse information. CHECAR DOLBLE NO CORRESPONDE

Birthdate
Month
Day
Year
Country/Region of Origin (Nationality)
Country/Region

Present Work/Education/Training Information

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

Primary Occupation
Present employer or school address:
Start Date
Month
Day
Year

Previous Work/Education/Training Information

NOTE: Provide your employment information for the last five years that you were employed, if applicable.

Multi choice
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