US VISA APPLICATION QUESTIONNAIRE

US VISA APPLICATION QUESTIONNAIRE

Please fill in the following information truthfully and precise as possible. Omit any question or section that is inapplicable.
Name Provided*

First Name(s)Middle NameLast Name(s)
Sex

MaleFemale
Marital Status

SingleMarriedWidowedDivorcedOther
Date of Birth

DayMonthYear
Date
Place of Birth
Nationality
Other Nationalities
National Identification Number
U.S. Social Security Number
U.S. Taxpayer ID Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Same Mailing Address

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Area CodePhone Number
Mobile/Cell Phone Number

Area CodePhone Number
Email Address
E.g Visa@example.com
Do you have a social media presence?

YesNo
Social Media Provider

FacebookInstagramTwitterLinkedInSnapChatOther
Social Media Handle
Facebook
Social Media Handle
Instagram
Social Media Handle
Twitter
Social Media Handle
LinkedIn
Social Media Handle
SnapChat
Social Media Handle
Other
Have you used any additional social media handle in the past 5 years?

YesNo
Please state social media provider and handle
eg. Facebook-john doe
Passport Number
Country/Authority that Issued Passport
City Where Issued
Country Where Issued
Issuance Date

DayMonthYear
Date
Expiration Date

DayMonthYear
Date
Have you ever lost a passport or had one stolen?

YesNo
Explain Reason
Purpose of Your Trip to U.S

B1-BusinessB2-TouristB1/B2- Tourist/Business
Intended Date of Arrival

DayMonthYear
Date
Intended Length of Stay in U.S.
Address where you will stay in the U.S

Street Address

Street Address Line 2

CityState

Zip Code
Name of Person Paying for Your Trip

First NameLast Name
Phone Number

Country CodeArea CodePhone Number
Email Address
example@example.com
Relationship to You
Is the address of the party paying for your trip the same as your Home or Mailing Address?

YesNo
Paying Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Persons Traveling with You?

YesNo
How Many Personas are Travelling with You?
Person #1
Person #2
Person #3
Person #4
Are you traveling as part of an organization?

YesNo
Name of the Organization
Have you ever been 10 printed?

YesNo
Have you ever been in the U.S.?

YesNo
Have you ever been issued a U.S. visa?

YesNo
Please State
Have you ever been refused a U.S. Visa?

YesNo
Explain
Contact Person Name in the U.S

PrefixFirst NameMiddle NameLast Name
Name of the Organization in the US
Relationship with you
Email Address
example@example.com
Phone Number

Country CodeArea CodePhone Number
U.S. Contact Address

Street Address

Street Address Line 2

CityState

Zip Code
Father
Mother
Do you have any immediate relatives not including parents in the U.S.?

YesNo
Relative
Spouse
Primary Occupation
Present Employer or School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Monthly Salary in Local Currency
Briefly Describe your Duties
Were you previously employed?

YesNo
Primary Occupation
Present Employer or School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Monthly Salary in Local Currency
Briefly Describe your Duties
Have you attended any educational institutions at a secondary level or above?

yesno
Institution Name
Address

Street Address

Street Address Line 2

CityParish

Country/Regeion
Course of Study
Date started

MonthDayYear
Date
Date ended

MonthDayYear
Date

other institution
Institution Name
Address

Street Address

Street Address Line 2

CityParish

Country/Regeion
Course of Study
Date started

MonthDayYear
Date
Date ended

MonthDayYear
Date

Almost done...
Countries Visited
Signature

Clear
Should be Empty: