DS160 Form — All fields optional

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REFERENCE CONSULTANT (Whose client is this?)

PERSONAL INFORMATION 1

SURNAME AS IN PASSPORT

GIVEN NAME AS IN PASSPORT

HAVE YOU EVER USED OTHER NAMES? (i.e, maiden, religious, professional, alias etc?)

SEX

DATE OF BIRTH

MARITAL STATUS

PLACE OF BIRTH

PERSONAL INFORMATION 2

NATIONALITY

DO YOU HOLD OR HAVE YOU HELD A NATIONALITY OTHER THAN THE ONE YOU HAVE INDICATED ABOVE

NATIONAL IDENTIFICATION NUMBER

US SOCIAL SECURITY NUMBER

US TAX PAYER ID NUMBER

TRAVEL INFORMATION

ARE YOU THE PRINCIPLE APPLICANT (CATEGORY: B1, B2, F1, J1)

PURPOSE OF TRIP TO THE US (BUSINESS OR TOURIST OR STUDY)

INTENDED DATE OF ARRIVAL

INTENDED LENGTH OF STAY

ADDRESS WHERE YOU WILL STAY IN US (STREET, CITY, STATE)

PHONE NUMBER

E-MAIL ID

PERSON/ENTITY PAYING FOR YOUR TRIP (NAME, SURNAME, ADDRESS - STREET, CITY, STATE, COUNTRY)

RELATIONSHIP TO YOU

TRAVEL COMPANIONS INFORMATION

ARE THERE OTHER PERSON TRAVELLING WITH YOU (IF YES PLEASE PROVIDE THE BELOW)

SURNAME

GIVEN NAME

RELATIONSHIP

ARE YOU TRAVELLING AS A PART OF A GROUP OR ORGANIZATION

PREVIOUS US TRAVEL INFORMATION

HAVE YOU EVER BEEN IN THE US? (IF YES PLEASE PROVIDE THE BELOW DETAILS)

VISIT 1 - DATE (DD/MM/YYYY)

VISIT 1 - LENGTH OF STAY

VISIT 2 - DATE

VISIT 2 - LENGTH OF STAY

VISIT 3 - DATE

VISIT 3 - LENGTH OF STAY

VISIT 4 - DATE

VISIT 4 - LENGTH OF STAY

VISIT 5 - DATE

VISIT 5 - LENGTH OF STAY

HAVE YOU EVER BEEN ISSUED US VISA? (IF YES PLEASE PROVIDE THE BELOW DETAILS)

VISA NUMBER (PRINTED IN RED COLOUR IN YOUR VISA)

DATE OF VISA ISSUE

TYPE OF VISA

HAVE YOU EVER BEEN REFUSED/WITHDRAWN US VISA (IF YES, PLEASE PROVIDE THE REASON)

HAVE YOU BEEN TEN PRINTED (NOT FOR FIRST TIME TRAVELLER)

ADDRESS INFORMATION

HOME ADDRESS

MAILING ADDRESS

IS YOUR MAILING ADDRESS SAME AS YOUR HOME ADDRESS

HOME TELEPHONE NUMBER

WORK PHONE NUMBER

WORK FAX NUMBER

MOBILE NUMBER

EMAIL ADDRESS

FACEBOOK ID

TWITTER ID

PASSPORT INFORMATION

PASSPORT NUMBER

COUNTRY/AUTHORITY THAT ISSUED PASSPORT

WHERE WAS THE PASSPORT ISSUED - CITY

WHERE WAS THE PASSPORT ISSUED - STATE

WHERE WAS THE PASSPORT ISSUED - COUNTRY

DATE OF ISSUE

DATE OF EXPIRY

HAVE YOU EVER LOST A PASSPORT OR HAD STOLEN

US POINT OF CONTACT INFORMATION

CONTACT PERSON SURNAME AND GIVEN NAME

ORGANIZATION NAME

RELATIONSHIP TO YOU

ADDRESS OF THE POINT OF CONTACT

PHONE NUMBER

EMAIL ID

FAMILY INFORMATION

FATHER'S SURNAME

FATHER'S GIVEN NAME

FATHER'S DATE OF BIRTH

IS YOUR FATHER IN US

MOTHER'S SURNAME

MOTHER'S GIVEN NAME

MOTHER'S DATE OF BIRTH

IS YOUR MOTHER IN US

DO YOU HAVE ANY IMMEDIATE RELATIVES IN US, NOT INCLUDING PARENTS? (LIKE SPOUSE, SIBLING)

SURNAME

GIVEN NAME

IMMIGRANT STATUS

SPOUSE SURNAME

SPOUSE GIVEN NAME

SPOUSE'S DATE OF BIRTH

SPOUSE NATIONALITY

SPOUSE PLACE OF BIRTH

SPOUSE ADDRESS

PRESENT WORK/EDUCATION/TRAINING

PRIMARY OCCUPATION CHOOSE FROM THE ABOVE (e.g. AGRICULTURE, ARTIST, BUSINESS, STUDENT, OTHER)

PRESENT EMPLOYER NAME

EMPLOYER STREET ADDRESS (LINE 1)

EMPLOYER STREET ADDRESS (LINE 2)

CITY

STATE/PROVINCE

POSTAL ZONE/ZIP CODE

COUNTRY

TELEPHONE NUMBER

EMAIL ID

JOB TITLE

EMPLOYMENT START DATE

MONTHLY SALARY

BRIEFLY DESCRIBE YOUR DUTIES

IF NOT EMPLOYED OR HOMEMAKER WERE YOU PREVIOUSLY EMPLOYED?

PREVIOUS WORK INFORMATION

WERE YOU PREVIOUSLY EMPLOYED?

EMPLOYER NAME

EMPLOYER STREET ADDRESS (LINE 1)

EMPLOYER STREET ADDRESS (LINE 2)

CITY

STATE/PROVINCE

POSTAL ZONE/ZIP CODE

COUNTRY

TELEPHONE NUMBER

JOB TITLE

SUPERVISOR'S SURNAME

SUPERVISOR'S GIVEN NAME

EMPLOYMENT DATE FROM

EMPLOYMENT DATE TO

BRIEFLY DESCRIBE YOUR DUTIES

ACADEMIC INFORMATION

SCHOOL/COLLEGE LAST STUDIED WITH COMPLETE ADDRESS

PERIOD OF STUDY (DD/MM/YYYY to DD/MM/YYYY)

COURSE LAST STUDIED

ANY OTHER ADDITIONAL DIPLOMA COURSES ATTENDED IF SO PLEASE MENTION

ADDITIONAL INFORMATION

HAVE YOU TRAVELLED TO ANY COUNTRIES WITHIN THE LAST FIVE YEARS? IF YES, LIST THEM.

LIST OF LANGUAGES YOU KNOW TO SPEAK

HAVE YOU BELONGED TO, CONTRIBUTED TO, OR WORKED FOR ANY PROFESSIONAL, SOCIAL, OR CHARITABLE ORGANIZATIONS? IF YES, PROVIDE NAMES

DO YOU HAVE ANY SPECIALIZED SKILLS OR TRAINING, INCLUDING FIREARMS, EXPLOSIVES, NUCLEAR, BIOLOGICAL, OR CHEMICAL EXPERIENCE?

TEMPORARY WORK INFORMATION (FOR H1B VISA)

WHERE DO YOU INTEND TO WORK

NAME OF THE EMPLOYER

U S STREET ADDRESS

CITY

PINCODE

STATE

ENTER MONTHLY SALARY (IN USD)

DO YOU HAVE AN APPLICATION RECEIPT/PETITION NUMBER (IF YES, PROVIDE BELOW DETAILS)

NAME OF PERSON/COMPANY WHO FILED PETITION

APPLICATION RECEIPT/PETITION NUMBER?

I-20/DS 2019 INFORMATION (FOR F1/J1 CATEGORY)

ADDITIONAL POINT OF CONTACT 1 - NAME

ADDRESS

CITY

STATE

TELEPHONE NUMBER

ADDITIONAL POINT OF CONTACT 2 - NAME

ADDRESS

CITY

STATE

TELEPHONE NUMBER

SEVIS ID

DO YOU INTEND TO STUDY IN US?

NAME OF THE SCHOOL

COURSE OF STUDY

STREET ADDRESS

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