US VISA APPLICATION DS-160

US VISA APPLICATION DS-160
PERSONAL INFORMATION
Application Date*

MonthDayYear
Full Name*

First NameLast Name
Have you used other names before

YESNO
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Day Time Phone*

Area CodePhone Number
E-mail*
DOB*

MonthDayYear
Place of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SEX*
MARITAL STATUS*

Nationality *
Do you hold or have held any other nationality*
Yes No
Are you a Permanent Resident of nay other country *
Yes No
US SSN Number*
National ID Number *
US Tax ID Number *
TRAVEL INFORMATION
Purpose of your trip to the US*
Business Pleasure
Have you made specific travel plans

YESNO
Intended Date of Travel

MonthDayYear
Intended length of stay
Address you will be staying in the US

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Person / entity paying for your trip

Please provide all social media provider/ platforms for the past five years
Please provide all social media identifier for the last five years
Do you wish to provide information about your presence on other websites for the past five years

YESNO
PASSPORT INFORMATION
Travel Document / Passport Type
eg: Regular, Official, Diplomatic, other
Travel Document Number
Country that issue Passport/ Travel Document
Where was the document issued
Address

Street Address

CityState / Province

Postal / Zip Code
Issuance Date

MonthDayYear
Expiration Date

MonthDayYear
Have you ever had a Passport lost or stolen

YESNO

US POINT OF CONTACT
Contact person or Organization the US
Full Name*

First NameLast Name
Organization name
Relationship to you
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone*

Area CodePhone Number
Email Address

FAMILY INFORMATION/ RELATIVE
Father's Full Name and DOB*

First NameLast Name
Date OF BIRTH

MonthDayYear
Is your Father in the US
Mother's Full Name and DOB*

First NameLast Name
Date OF BIRTH

MonthDayYear
Is your Mother in the US
Do you have immediate Relative not including your Parents in the US

YESNO
Do you have other Relative in the US

YESNO

PRESENT WORK/ EDUCATION/TRAINING INFORMATION
Primary Occupation
Present Employer or School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date

MonthDayYear
Montly income if employed
Briefly describe your duties
Were you previously employed

YESNO
Have you attended any education institution at a secondary level or above

YESNO
Name of institution
Start Date

MonthDayYear
End Date

MonthDayYear
Name of institution
Start Date

MonthDayYear
End Date

MonthDayYear
Name of institution
Start Date

MonthDayYear
End Date

MonthDayYear

Type Signature*
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Jamaican Visa Application Fee$260.00
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