DS160 Temporary Visa application USA Dummy form

DS160 Temporary Visa application USA Dummy form

Please use UPPE CASE LETTERS only
Customer number *
Starting with CU check your invoice of visa processing
Invoice number *
Starting wiht FA check your invoice for visa processing
Surnames *
As per passport
Given Names *
Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)? *

Yes No
Provide Following information if your answer is yes in above question no: 3. Otherwise leave question 3.1 to 3.2 blank

You can provide up to one name changes if you have change your names more than once please contact us by email at visaservices@ayanaacademy.com
Other Surnames Used (maiden, religious, professional, aliases, etc.)
Only use this if you have change your name after marriage
Other Given Names Used
Sex *

Female Male
Marital Status *
DATE AND PLACE OF BIRTH

If day or month is unknown, enter as shown in passport.
DATE *
DD
MONTH *
MMM
YEAR *
YYYY
City of Birth *
As per your passport
Province of Birth if given in passport
If not shown in passport then tick Does not Apply
STATE/ PROVINCE

DOES NOT APPLY
8 Country of Birth *

Travel Companions Information
Are there other persons travelling with you? *

YES NO
Are you travelling as part of a group or organisation?

YES NO
Group Name
HOW MANY PEOPLE ARE TRAVELLING WITH YOU?
If more than 5 people are travelling please let us know.
Name of Person 1

Surname Given Name
Relationship with Person 1
Name of Person 2

Surname Given Name
Relationship with Person 2
Name of Person 3

Surname Given Name
Relationship with Person 3
Name of Person 4

Surname Given Name
Relationship with Person 4
Name of Person 5

Surname Given Name
Relationship with Person 5

Address and Phone Information
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country *
Mailing Address
Is your Mailing Address the same as your Home Address? *

YES NO
Mailing Address Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country of mailing address
Primary mobile Number *
(91) (10 digit mobile number)
secondary mobile Number
(91) (10 digit mobile number)
Home landline number
(91) (10 digit mobile number)
Have you use any other number in past fiver years? *

YES NO
Give additional number details
(91) (10 digit mobile number)
Email *
example@example.com
Have you use any other email address in past fiver years? *

YES NO
Additional Email
example@example.com
Do you have a social media presence? *

YES NO
Give the social media platform with it's user name/ identifier

Passport Information
PASSPORT # *
Country of Issue *
City of Issue *
State of Issue *
Date of Issue *
ex:09-SEP-2022
Date of Expiry *
ex:09-SEP-2022
Have you ever lost a passport or had one stolen? *

YES NO
Give detail about the lost/stolen passport

U.S. Point of Contact Information

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.
Does not know a Person
Organisation Name
Does not know an Organisation
Name of person

Surname Given Name
Relationship to you *
Address of person or organization *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email of person/organization *
example@example.com
Phone number of person/organization

Family Information: Spouse

Spouse's Full Name (include Maiden Name)
Spouse Full name

Last Name Given Name
Date of birth Spouse *
ex:04-NOV-1977
Spouse Country of Origin (Nationality) *
Spouse City of Birth *
Spouse Country of Birth *
Spouse's address

Present Work/Education/Training Information
Primary Occupation
Present Employer/School Name
School/ Work address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country of work
Work Phone Number
Work Mobile Number
(091)(10 digit mobile number)
Start Date
ex:04-NOV-1977
Montly income in local currency
Describe your duties

Previous Work/Education/Training Information

NOTE: Provide your employment information for the last five years that you were employed, if applicable.
Where you Previously Employed? *

YES NO
Previous Employer
Previous Work address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country of Previous Work
Start Date of Previous Work
ex:04-NOV-1977
End Date of Previous work
ex:04-NOV-1977
Phone Number of Previous Work
How many more previous work you need to add?
If you want to add more details please email us on visaservices@sg4ge.co.uk
Give Details of your experience-1 Give company/employer name, address, phone number, start date and end date
Give Details of your experience-2 Give company/employer name, address, phone number, start date and end date
Give Details of your experience-3 Give company/employer name, address, phone number, start date and end date
Have you attended any educational institutions at a secondary level or above? *

YES NO
Name of Institute
Address of Institute

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country of Study
Course of Study
Start Date of Study
ex.04-NOV-1977
End Date of Study
ex.04-NOV-1977
How many more study details you would like to add
If you want to add more details please email us on visaservices@sg4ge.co.uk
Give detail of study -1 with Name of Institute, Address of Institute, Country of Institute, Start and End dates and Course of Study
Give detail of study -2 with Name of Institute, Address of Institute, Country of Institute, Start and End dates and Course of Study
Give detail of study -3 with Name of Institute, Address of Institute, Country of Institute, Start and End dates and Course of Study

Security and Background: Part 1
NOTE: Provide the following security and background information. Provide complete and accurate answers to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.
Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as determined by the Department of Health and Human Services.) *

YES NO
Explain Communicable diseas
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others? *

YES NO
Explain mental or physical disorder
Are you or have you ever been a drug abuser or addict? *

YES NO
Explain drug abuse

Security and Background: Part 4
Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or willful misrepresentation or other unlawful means? *

YES NO
Explain illegal visa by fraud
Have you ever been removed or deported from any country? *

YES NO
Explain Deportation

Security and Background: Part 5
Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court? *

YES NO
Explain Child custody out of USA
Have you voted in the United States in violation of any law or regulation? *

YES NO
Explain voted in violation
Have you ever renounced United States citizenship for the purposes of avoiding taxation? *

YES NO
Explain renounced us citizenship for avoiding tax
Please verify that you are human *
Should be Empty:

DS160 Temporary Visa application USA Dummy form

Provide Following information if your answer is yes in above question no: 3. Otherwise leave question 3.1 to 3.2 blank

DATE AND PLACE OF BIRTH

PERSONAL INFORMATION

Travel Companions Information

Previous U.S. Travel Information

Address and Phone Information

Mailing Address

Passport Information

U.S. Point of Contact Information

Family Information: Relatives

Family Information: Spouse

Present Work/Education/Training Information

Previous Work/Education/Training Information

Additional Work/Education/Training Information

If you want to add more details about your military services to other countries please email us

Security and Background: Part 1

Security and Background: Part 2

Security and Background: Part 3

Security and Background: Part 4

Security and Background: Part 5