Form DS-156 Nonimmigrant Visa Application

Approved OMB 1405-0018
Expires 09/30/2007
Estimated Burden 1 hour
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U.S. Department of State

NONIMMIGRANT VISA APPLICATION
PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM
1. Passport Number

DO NOT WRITE IN THIS SPACE

2. Place of Issuance:
City

Country

State/Province

B-1/B-2 MAX

B-1 MAX

B-2 MAX

Other

MAX
Visa Classification

4. Issuance Date (dd-mmm-yyyy)

3. Issuing Country

5. Expiration Date (dd-mmm-yyyy) Mult or
Number of Applications
Months

6. Surnames (As in Passport)

Validity
Issued/Refused
By

On

7. First and Middle Names (As in Passport)

Under SEC.

8. Other Surnames Used (Maiden, Religious, Professional, Aliases)

214(b)

221(g)

Other

INA

Reviewed By

9. Other First and Middle Names Used

11. Place of Birth
City

13. Sex
Male

10. Date of Birth (dd-mmm-yyyy)

12. Nationality
State/Province

Country

14. National Identification Number

15. Home Address (Include Apartment Number, Street, City, State or Province, Postal Zone and Country)

(If Applicable)

Female
16. Home Telephone Number
Fax Number
17. Marital Status
Married

Business Phone Number

Mobile/Cell Number

Business Fax Number

Pager Number

18. Spouse's Full Name (Even if divorced or separated, include maiden name.)
Single (Never Married)

19. Spouse's DOB (dd-mmm-yyyy)

Divorced
Separated
Widowed
20. Name and Address of Present Employer or School
Name
Address

21. Present Occupation (If retired, write "retired". If student,
write "student".)

22. When do you intend to arrive in the U.S.?
(Provide specific date if known)

23. E-Mail Address

24. At what address will you stay in the U.S.?

BARCODE
25. Name and telephone numbers of person in U.S. who you will be staying with
or visiting for tourism or business
Name
Home Phone
Business Phone

26. How long do you intend to
stay in the U.S.?

DO NOT WRITE IN THIS SPACE

Cell Phone

27. What is the purpose of your trip?

50 mm x 50 mm
PHOTO
staple or glue photo here

28. Who will pay for your trip?

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

Yes

No

When?
For how long?
DS-156
03-2006

PREVIOUS EDITIONS OBSOLETE

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30. Have you ever been issued a U.S. visa?
When?

Yes

No

31. Have you ever been refused a U.S. visa?
When?

Where?

Where?

What type of visa?

What type of visa?

32. Do you intend to work in the U.S.?

Yes

(If YES, give the name and complete address of U.S. employer.)

No

33. Do you intend to study in the U.S.?

Yes

No

Yes

No

(If YES, give the name and complete address of the school.)

34. Names and relationships of persons traveling with you

36. Has anyone ever filed an immigrant visa petition on your behalf?
35.Has your U.S. visa ever been cancelled or revoked?
Yes
No
Yes
No If Yes, who?
37. Are any of the following persons in the U.S., or do they have U.S. legal permanent residence or U.S. citizenship?
Mark YES or NO and indicate that person's status in the U.S. (i.e., U.S. legal permanent resident, U.S. citizen, visiting, studying, working, etc.).
Husband/
Fiance/
Yes
No
Yes
No
Yes
No
Wife
Fiancee
Brother/
Father/
Son/
Yes
No
Sister
Mother
Daughter
38. IMPORTANT: ALL APPLICANTS MUST READ AND CHECK THE APPROPRIATE BOX FOR EACH ITEM.
A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in
advance). Is any of the following applicable to you?
Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty or other similar
Yes
No
legal action? Have you ever unlawfully distributed or sold a controlled substance (drug), or been a prostitute or procurer for
prostitutes?
Yes

No

Have you ever been refused admission to the U.S., or been the subject of a deportation hearing, or sought to obtain or assist
others to obtain a visa, entry into the U.S., or any other U.S. immigration benefit by fraud or willful misrepresentation or other
unlawful means? Have you attended a U.S. public elementary school on student (F) status or a public secondary school after
November 30, 1996 without reimbursing the school?

Yes

No

Do you seek to enter the United States to engage in export control violations, subversive or terrorist activities, or any other
unlawful purpose? Are you a member or representative of a terrorist organization as currently designated by the U.S. Secretary
of State? Have you ever participated in persecutions directed by the Nazi government of Germany; or have you ever
participated in genocide?

Yes

No

Have you ever violated the terms of a U.S. visa, or been unlawfully present in, or deported from, the United States?

Yes

No

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S.
court, voted in the United States in violation of any law or regulation, or renounced U.S. citizenship for the purpose of avoiding
taxation?

Yes

No

Have you ever been afflicted with a communicable disease of public health significance or a dangerous physical or mental
disorder, or ever been a drug abuser or addict?

Yes

No

While a YES answer does not automatically signify ineligibility for a visa, if you answered YES you may be required to personally appear before a consular
officer.
39. Was this application prepared by another person on your behalf?
(If answer is YES, then have that person complete item 40.)
Yes
No
40. Application Prepared By
Name

Relationship to Applicant

Address
Signature of Person Preparing Form

Date (dd-mmm-yyyy)

41. I certify that I have read and understood all the questions set forth in this application and the answers I have furnished on this form are true and correct to
the best of my knowledge and belief. I understand that any false or misleading statement may result in the permanent refusal of a visa or denial of entry into the
United States. I understand that possession of a visa does not automatically entitle the bearer to enter the United States of America upon arrival at a port of
entry if he or she is found inadmissible.
Applicant's Signature

Date (dd-mmm-yyyy)

Privacy Act and Paperwork Reduction Act Statements
INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation, amendment, administration, or
enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be made available to a court which certifies that the information
contained in such records is needed in a case pending before the court.
Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the
necessary data, providing the information required, and reviewing the final collection. You do not have to provide the information unless this collection displays a currently valid OMB
number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State, A/ISS/DIR, Washington, DC 20520.

DS-156

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