Personal Information 1
Language of Interview
Surnames
Given Names
Have you ever used other names (i.e., maiden,
religious, professional, alias, etc.)
Sex (MALE/ FEMALE)
Marital Status
Date of Birth (DD-MM-YYYY)
Place of Birth
State/Province
Country/Region
U.S. Taxpayer ID Number
Travel Information
Purpose of Trip to the U.S. (Tourist, Business,
Family/friend visit)
Intended Date of Arrival (DD-MM-YYYY)
Intended Length of Stay in U.S
Address Where You Will Stay in the U.S.
Street Address
City
State
Zip code
Person/Entity Paying for Your Trip (self/ other
person/present employer/
employer in US/ other company/organization)
If person entity is not “SELF” please provide below
details
Surnames of Person Paying for Trip
Given Names of Person Paying for Trip
Telephone Number
Email address
Sponsor Relationship to you
(child/parent/spouse/other relative/friend/ other)
Is the address of the party paying for your trip
the same as your Home or Mailing Address?
Travel Companions Information
Are there other persons traveling with you?
If Yes
Surnames of Person Traveling With You
Given Names of Person Traveling With You
Relationship with Person (parent/ spouse/child/
other relative/
friend/ business associate/ other)
Previous U.S. Travel Information
Have you ever been in the U.S.?
If yes (Provide information on your last five U.S.
visits)
Date of arrived (DD-MM-YYYY)
Length of stay
Do you or did you ever hold a U.S. Driver’s License?
Have you ever been issued a U.S. Visa?
If yes
Date Last Visa Was Issued (DD-MM-YYYY)
Visa Number e.g. E4000009
Are you applying for the same type of visa?
Are you applying in the same country or location where
the visa above was issued,
and is this country or location your place of principal of
residence?
Have you been ten-printed? (Biometric done after 2008)
Has your U.S. Visa ever been lost or stolen?
Has your U.S. Visa ever been cancelled or revoked?
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or withdrawn your application for admission at the port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
City
State/Province
Postal Zone/ZIP Code
Country/Region
Is your Mailing Address the same as your Home Address?
Primary Phone Number
Secondary Phone Number
Work Phone Number
Have you used any other phone numbers in the last five
years?
Email Address
Have you used any other email addresses in the last five
years?
Social Media Provider/Platform (Google+, Facebook,
Instagram,Twitter,
YouTube, LinkedIn)
Social Media Id
Do you wish to provide information about your presence
on any other
websites or applications you have used within the
last five years to create or share content (photos,
videos, status updates, etc.)?
Passport Information
Passport type
Passport/Travel Document Number
Country/Authority that Issued Passport/Travel Document
City
State/Province
Country/Region
Passport issue date (DD-MM-YYYY)
Expiry Date (DD-MM-YYYY)
Have you ever lost a passport or had one stolen?
U.S. Point of Contact Information
Contact person Surname
Contact person Given name
If organization/Hotel, please mentioned name
Relationship to You (Relative/ Spouse/ Friend/
Business Associate/ Employer/ School official/
Other)
Address and Phone Number
City
State
ZIP Code
Phone Number
Email Address
Family Information: Relatives
Father's Full Name and Date of Birth
Surnames
Given Names
DOB (DD-MM-YYYY)
Is your father in the U.S.?
Mother's Full Name and Date of Birth
Surnames
Given Names
DOB (DD-MM-YYYY)
Is your MOTHER in the U.S.?
Do you have any immediate relatives, not including
parents, in the United States?
If yes
Surnames
Given Names
Relationship to You (Spouse/ Fiancé/ Child/ Sibling)
Do you have any other relatives in the United States?
Yes/No
If yes
Relative's Status (US citizen/ US Legal permanent/
Non-immigrant/other/Don’t know)
Family Information: Spouse
Spouse's Surnames
Spouse's Given Names
Spouse's Date of Birth (DD-MM-YYYY)
Spouse's Country/Region of Origin (Nationality)
Spouse's Place of Birth
City
Country/Region
Spouse's Address
Present Employment Details (For Student applicant please specify University details)
Primary Occupation
Present Employer or University Name
Present employer name
Street Address
City
State
Postal code
Phone no
Country
Start Date (DD-MM-YYYY)
Monthly Income in Local Currency (if employed)
Briefly describe your duties:
Previous employment details (Please mention details of the organization you worked in the last
5 years)
We can only mention 2 entries
Were you previously employed?
If yes
Employer Name
Street address
City
State
Postal code
Telephone / phone no
Country
Job Title
Supervisor's Surname
Supervisor's Given Names
Employment Date From (DD-MM-YYYY)
Employment Date To (DD-MM-YYYY)
Briefly describe your duties:
Educational Details (Please mention only 2
entries)
Have you attended any educational institutions at a
secondary level or above?
If yes
Name of Institution
Street Address
City
Postal code
Telephone / Phone no
Country
Course of Study
Date of Attendance From (DD-MM-YYYY)
Date of Attendance To (DD-MM-YYYY)
Do you belong to a clan or tribe?
Provide a List of Languages You Speak
(English/Hindi/Marathi or etc)
Language Name
Have you traveled to any countries/regions within the
last five years?
If yes, Provide a List of Countries/Regions Visited
Have you belonged to, contributed to, or worked for
any professional, social, or charitable organization?
Do you have any specialized skills or training, such as
firearms,
explosives, nuclear, biological, or chemical experience?
Have you ever served in the military?
Have you ever served in, been a member of, or been
involved with a paramilitary unit,
vigilante unit, rebel group, guerrilla group, or insurgent
organization?
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DETAILS ASKED BELOW ARE COMPLETELY FILLED