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Edit Personal Information

The document contains personal information for SHANTHA KUMARI, including her marital status, date of birth, and contact details. It outlines her travel plans to the U.S. for temporary business or pleasure, along with information about her spouse and family. Additionally, it includes her passport details and responses to various questions regarding her background and legal history.

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deesha.n
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© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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0% found this document useful (0 votes)
5 views10 pages

Edit Personal Information

The document contains personal information for SHANTHA KUMARI, including her marital status, date of birth, and contact details. It outlines her travel plans to the U.S. for temporary business or pleasure, along with information about her spouse and family. Additionally, it includes her passport details and responses to various questions regarding her background and legal history.

Uploaded by

deesha.n
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Edit Personal Information

Name Provided: SHANTHA KUMARI, SHANTHA KUMARI

Full Name in Native Alphabet: DOES NOT APPLY

Other Names Used: NO

Telecode Name Used: NO

Sex: FEMALE

Marital Status: MARRIED

Date of Birth: 24 JUNE 1961

Country/Region of Birth: BENGALURU, KARNATAKA, INDIA

Country/Region of Origin (Nationality): INDIA

Do you hold or have you held any


nationality other than the one NO
indicated above on nationality?

Are you a permanent resident of a


country/region other than your
NO
country/region of origin (nationality)
above?

National Identification Number: DOES NOT APPLY

U.S. Social Security Number: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Edit Address and Phone Information

174,179 M S HOMES ,2ND A CROSS RK


Home Address:
GARDEN

NEW BEL ROAD


City: BENGALURU

State/Province: KARNATAKA

Postal Zone/ZIP Code: 560054

Country/Region: INDIA

Same Mailing Address? YES

Primary Phone Number: 9901646130

Secondary Phone Number: DOES NOT APPLY

Work Phone Number: DOES NOT APPLY

Have you used additional phone


NO
numbers in the last five years?

Email Address: mgovindaraju.174@[Link]

Have you used additional email


NO
addresses in the last five years?

Do you have a social media presence?

Social Media Provider/Platform (1): None

Social Media Identifier:

Have you used additional social media


NO
platforms in the last five years?

Edit Passport/Travel Document Information

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: Z7398573

Passport Book Number: DOES NOT APPLY

Country/Authority that Issued INDIA


Passport/Travel Document:

City where issued: BENGALURU

State/Province where issued: KARNATAKA

Country/Region where issued: INDIA

Issuance Date: 01 FEBRUARY 2024

Expiration Date: 31 JANUARY 2034

Have you ever lost a passport or had


NO
one stolen?

Edit Travel Information

The List of Purposes of Trip to the U.S.

TEMP. BUSINESS OR PLEASURE


Purpose of Trip to the U.S. (1):
VISITOR (B)

BUSINESS OR TOURISM
Specify:
(TEMPORARY VISITOR) (B1/B2)

Have you made specific travel plans? NO

Intended Date of Arrival: 15 AUGUST 2026

Intended Length of Stay in U.S.: 15 DAY(S)

Address where you will stay in the U.S.: 4221 CANADIAN RIVER DR

PROSPER

TEXAS, TEXAS 75078

Person/Entity Paying for Your Trip: SELF

Edit Travel Companions Information


Other Persons Traveling with You: YES

Are you traveling as part of a group or


NO
organization?

Persons Traveling with You:

MUNIVENKATAPPA , GOVINDA
Name (1):
RAJU

Relationship to You: SPOUSE

Edit Previous U.S. Travel Information

Have you ever been in the U.S.? NO

Have you ever been issued a U.S. visa? NO

Have you ever been refused a U.S. Visa,


or been refused admission to the
United States, or withdrawn your YES
application for admission at the port of
entry?

NO PROOF OF COMING BACK TO IND


Explain:
IA

Has anyone ever filed an immigrant


petition on your behalf with the United
NO
States Citizenship and Immigration
Services?

Edit U.S. Point of Contact Information

Contact Person Name in the U.S.: SEKHAR, RAJA

Organization Name in the U.S.: DO NOT KNOW

Relationship to You: RELATIVE


U.S. Contact Address: 4221 CANADIAN RIVER DR

PROSPER

TEXAS, TEXAS 75078

Phone Number: +14694766210

Email Address: rajasekhar90@[Link]

Edit Family Information: Relatives

Father's Surnames: DO NOT KNOW

Father's Given Names: RAMACHANDRAPPA

Father's Date of Birth: DO NOT KNOW

Is your father in the U.S.? NO

Mother's Surnames: DO NOT KNOW

Mother's Given Names: SUBBALAKSHMAMMA

Mother's Date of Birth: DO NOT KNOW

Is your mother in the U.S.? NO

Do you have any immediate relatives,


NO
not including parents in the U.S.?

Do you have any other relatives in the


NO
United States?

Edit Family Information: Spouse

Spouse's Full Name: MUNIVENKATAPPA, GOVINDA RAJU

Spouse's Date of Birth: 01 FEBRUARY 1952

Spouse's Country/Region of Origin INDIA


(Nationality):

Spouse's City of Birth: BENGALURU

Spouse's Country/Region of Birth: INDIA

Spouse’s Address: SAME AS MAILING ADDRESS

Edit Present Work Information

Primary Occupation: HOMEMAKER

Edit Previous Work Information

Were you previously employed? NO

Have you attended any educational


institutions at a secondary level or NO
above?

Edit Additional Information

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): KANNADA

Language Name (2): ENGLISH

Language Name (3): HINDI

Language Name (4): TAMIL

Have you traveled to any


countries/regions within the last five YES
years?

Provide a List of Countries/Regions Visited


Country/Region(1): SRI LANKA

Country/Region(2): KOREA, REPUBLIC OF (SOUTH)

Country/Region(3): MALAYSIA

Country/Region(4): THAILAND

Have you belonged to, contributed to,


or worked for any professional, social, NO
or charitable organization?

Do you have any specialized skills or


training, such as firearms, explosives,
NO
nuclear, biological, or chemical
experience?

Have you ever served in the military? NO

Have you ever served in, been a


member of, or been involved with a
paramilitary unit, vigilante unit, rebel NO
group, guerrilla group, or insurgent
organization?

Edit Part 1

Do you have a communicable disease of public health significance?


(Communicable diseases of public significance include chancroid,
gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma
NO
venereum, infectious stage syphilis, active tuberculosis, and other
diseases as determined by the Department of Health and Human
Services.)

Do you have a mental or physical disorder that poses or is likely to pose a


NO
threat to the safety or welfare of yourself or others?

Are you or have you ever been a drug abuser or addict? NO

Edit Part 2
Have you ever been arrested or convicted for any offense or crime, even
NO
though subject of a pardon, amnesty, or other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law


NO
relating to controlled substances?

Are you coming to the United States to engage in prostitution or unlawful


commercialized vice or have you been engaged in prostitution or NO
procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money
NO
laundering?

Have you ever committed or conspired to commit a human trafficking


NO
offense in the United States or outside the United States?

Are you the spouse, son, or daughter of an individual who has committed
or conspired to commit a human trafficking offense in the United States
NO
or outside the United States and have you within the last five years,
knowingly benefited from the trafficking activities?

Have you knowingly aided, abetted, assisted or colluded with an


individual who has committed or conspired to commit a severe human NO
trafficking offense in the United States or outside the United States?

Edit Part 3

Do you seek to engage in espionage, sabotage, export control violations,


NO
or any other illegal activity while in the United States?

Do you seek to engage in terrorist activities while in the United States or


NO
have you ever engaged in terrorist activities?

Have you ever or do you intend to provide financial assistance or other


NO
support to terrorists or terrorist organizations?

Are you a member or representative of a terrorist organization? NO

Are you the spouse, son, or daughter of an individual who has engaged in NO
terrorist activity, including providing financial assistance or other support
to terrorists or terrorist organizations, in the last five years?

Have you ever ordered, incited, committed, assisted, or otherwise


NO
participated in genocide?

Have you ever committed, ordered, incited, assisted, or otherwise


NO
participated in torture?

Have you committed, ordered, incited, assisted, or otherwise


participated in extrajudicial killings, political killings, or other acts of NO
violence?

Have you ever engaged in the recruitment or the use of the child
NO
soldiers?

Have you, while serving as a government official, been responsible for or


directly carried out, at any time, particularly severe violations of religious NO
freedom?

Have you ever been directly involved in the establishment or


enforcement of the population controls forcing a woman to undergo an
NO
abortion against her free choice or a man or a woman to undergo
sterilization against his or her free will?

Have you ever been directly involved in the coercive transplantation of


NO
human organs or bodily tissue?

Edit 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 NO
fraud or willful misrepresentation or other unlawful means?

Have you ever been removed or deported from any country? NO

Edit Part 5
Have you ever withheld custody of a U.S. citizen child outside the United
NO
States from a person granted legal custody by a U.S. court?

Have you voted in the United States in violation of any law or regulation? NO

Have you ever renounced United States citizenship for the purpose of
NO
avoiding taxation?

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