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pdfOMB APPROVAL NO 1405-0018
EXPIRATION DATE XX/XX/20XX
ESTIMATED BURDEN: 90 MINUTES
U.S. Department of State
CONSOLIDATED NONIMMIGRANT VISA APPLICATION
PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM
PASSPORT INFORMATION
Surname (as on passport)
Passport Travel Document
Type
First and Middle Names (as on passport)
Passport Number
Issuing Country
Place of Issuance - City
Place of Issuance - Country
Issuance Date (mm-dd-yyyy)
Place of Issuance
State/Province
Expiration Date (mm-dd-yyyy)
Have you ever lost a passport or had one stolen? If Yes, Please Provide Passport/Travel Document Country/Authority that Issued Passport/Travel
Number
Document
Yes
No
Explain
BIOGRAPHICAL INFORMATION
Other Surnames Used (Maiden, Religious, Professional, Aliases)
Other First and Middle Names Used
Full Name in Native Alphabet
Place of Birth
Date of Birth (mm-dd-yyyy)
Sex
Male
City
Nationality
National Identification Number (if applicable)
Female
Country
State/Province
Country/Region of Origin (nationality)
Yes
No
Do you hold or have you held any nationality other than the one indicated above on nationality?
If Yes, Please Provide Name of Country/Region
If you hold a passport for the other country/region of origin/nationality,
please enter passport number.
Are you a permanent resident of a country/region other than your country or origin/region (nationality) form above?
If yes, please enter the Other Permanent Resident Country/Region.
Yes
No
ADDRESS INFORMATION
Please provide the following
information regarding your home
address.
Apartment Number
Street
City
State/Province
Postal Zone
Country
Is your mailing address your home address? If no, please provide the following information.
Apartment Number
Street
City
Please provide the following
information.
Country
DS-0156
03-2018
State/Province
Postal Zone
Page 1 of 19
PHONE INFORMATION AND EMAIL
Primary Phone Number
Secondary Phone Number
Work Number
Mobile/Cell Number
Have you used any other telephone numbers during the last five years? (If "Yes", list additional telephone numbers used in the space below.)
Yes
No
Email Address
Have you used any other email addresses during the last five years? (If "Yes", list additional email addresses used in the space below.)
Yes
No
SOCIAL MEDIA
Have you used any of the following social media platforms during the last five years? (If "Yes", provide social media identifier for platform.)
Platform
Answer
Social Media Identifier(s)
Ask.fm
Yes
No
Douban
Yes
No
Facebook
Yes
No
Flickr
Yes
No
Google+
Yes
No
Instagram
Yes
No
LinkedIn
Yes
No
Myspace
Yes
No
Pinterest
Yes
No
Qzone (QQ)
Yes
No
Reddit
Yes
No
Sina Weibo
Yes
No
Tencent Weibo
Yes
No
Tumbler
Yes
No
Twitter
Yes
No
Twoo
Yes
No
Vine
Yes
No
Vkontakte
Yes
No
Youku
Yes
No
YouTube
Yes
No
None of the Above
Yes
No
SOCIAL MEDIA - Optional
If you would like 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.), please list the platform and associated unique social media identifier (username or handle) below.
Platform
DS-0156
Social Media Identifier(s)
Page 2 of 19
TRAVEL INFORMATION (Please provide the following information concerning your travel plans.)
Purpose of the Trip to the United States
Specify
Person/Entity Paying for Your Trip
Surname of Person Paying for Your Trip
Given Names of Person Paying for Your Trip
Telephone of Person Paying for Your Trip
Email Address of Person Paying for Your Trip
Relationship to You
Intended Length of Stay in the U.S.
Intended Date of Arrival (mm-dd-yyyy)
Is the address of the party paying for your trip the same as your mailing address?
Yes
If no, please provide street address, city, state/province, postal zone/ZIP code, country/region.
No
Intended Arrival Flight Number (if known)
Intended Date of Departure (mm-dd-yyyy)
Departure Flight Number (if known)
Departure City
Please Provide Street Address of Where You
Intend to Stay
City/State
Zip Code
Are there persons traveling with you?
If yes, please provide the surname and given
name of person traveling with you.
Relationship with the Person
Yes
No
Are you traveling as part of a group or
organization?
Yes
No
If yes, please provide the name of the group you are traveling with.
PURPOSE OF TRIP TO UNITED STATES
If your purpose of travel is to come as a Student/Exchange Visitor (F1, F3, J1, M1, M3) please provide additional Point of Conact 1, additional Point of
Contact 2 and Sevis information.
Additional Point of Contact 1
Surname
Given Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country/Region
Telephone Number
Email Address
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Additional Point of Contact 2
Surname
Given Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country/Region
Telephone Number
Email Address
SEVIS INFORMATION
SEVIS ID
Principal Applicant SEVIS ID (if applicable)
Program Number (J1)
Do you intend to Study in the U.S.?
Name of School
Course of Study
Street Address (line 1)
Street Address (line 2)
City
State
Yes
No
If yes, explain
Postal Zone/Zip Code
If Your Purpose of Travel is to Come as a CREW MEMBER IN TRANSIT (C1/D) OR CREWMEMBER (D), Please Provide the Following Information
Specific Job Title Aboard Aircraft of Vessel
Company Telephone Number
Name of Company that Owns the Aircraft or Vessel you will be Working on
Did you acquire your position using a recruiting/manning/crewing agency?
Agency Name
Contact Given Name
State
Did you acquire your position using a recruiting/manning/crewing agency?
DS-0156
If yes, please provide the following:
Street Address (line 2)
Country/Region
Seagoing Ship/Vessel Name
No
Contact Surname
Street Address (line 1)
City
Yes
Postal Zone/Zip Code
Telephone Number
Yes
If yes, please provide the following:
Seagoing Ship/Vessel Identification Number
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Please fill out one of the following boxes depending on your Temporary Work Visa Class.
Temporary Work Visa information for A1, A2, (A3), E3, E3R, G5, H1B1, l, NATO1-NATO6 (NATO7), Q, TN Visa Applicants
Name of Employer
Monthly Income
U.S. Street Address (line 1)
U.S. Street Address (line 2)
City
State
Zip Code
Country Region
Phone Number
OR..
Temporary Work Visa Information for CW1, E2C, H1B, H1C, H2A, H2B, H3, L1, O1, O2, P1, P2, P3, R1 Visa Applicants
Application Receipt/Petition Number
Name of Person/Company who Filed Petition
Name of Employer
Monthly Income
U.S. Street Address (line 1)
U. S. Street Address (line 2)
City
State
Zip Code
Phone Number
Phone Number
OR..
Temporary Work Visa Information for E1or E2 Visa Applicants
Name of Employer
E Visa Company Registration Number
U.S. Street Address (line 1)
U. S. Street Address (line 2)
City
State
Phone Number
PREVIOUS U.S. TRAVEL INFORMATION
(Please provide the following previous U.S. travel information. Provide complete and accurate information to all questions that require an explanation.)
Did you acquire your position using a recruiting/manning/crewing agency?
Yes
No
If yes, please provide information on your last five U.S. visits.
Date of Arrival
(mm-dd-yyyy)
1.
2.
3.
4.
5.
Length of "Stay
If you have ever visited the U.S. please answer the following questions.
Have you ever been the subject of a removal or deportation hearing?
DS-0156
Yes
No
If yes, explain
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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 fraud or
willful misrepresentation or any other unlawful means?
Yes
No
If yes, explain.
Have you ever been unlawfully present in the U.S. for more than one year in the aggregate at any time during the past ten years?
Yes
No
If yes, explain.
Have you failed to attend a hearing on removability or or inadmissibility within the last five years?
Yes
No
If yes, explain.
Have you ever been unlawfully present, or overstayed the amount of time granted by an immigration official or otherwise violated the terms of a U.S.
Visa?
Yes
No
If yes, explain.
Have you ever been issued a U.S. Visa?
Yes
No
Do you or did you ever hold a U.S. Driver's License?
If yes, please provide the following information
Yes
No
Date last Visa was
Issued (mm-dd-yyyy)
State License Issued
Visa Number
License Number
If you were issued a U.S. Visa previously, are you applying for the same Visa?
If yes, please provide the following information.
Yes
No
a. Are you applying in the same country where the U.S. Visa above was issued?
Yes
No
b. Is this country your principal country of residence?
Yes
No
c. Have you ever been ten-printed?
Yes
No
d. Has your U.S. Visa ever been stolen?
Yes
No If yes, please provide year Visa was stolen.
Yes
No If yes, please explain.
If you were issued a U.S. Visa previously, please provide the following information
e. Has your U.S. Visa ever been cancelled or revoked?
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f. Have you ever been removed or deported from any country?
Yes
No If yes, please explain.
h. Have you ever been refused a U.S. Visa?
Yes
No If yes, please explain.
i. Have you ever been refused admission to the United States?
Yes
No If yes, please explain.
j. Have you ever had your application for admission at the port of entry withdrawn?
Yes
No If yes, please explain.
k. Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and immigration Services?
Yes
No If yes, please explain.
l. Have you ever been denied travel authorization by the Department of Homeland Security through the Electronic System for Travel Authorization?
m. Have you ever been a U.S. legal permanent resident?
Yes
No If yes, please explain.
Yes
No If yes, please explain.
U.S. POINT OF CONTACT
Your U.S. Point of Contact can be any individual in the U.S. who knows you and can verify, if necessary, your identity. If you do not personally know
anyone in the U.S., you may enter the name of the store, company or organization you plan to visit during your trip.
Contact Person (skip if you do not know)
Surnames
Given Names
Organization (skip if you do not know)
DS-0156
Organization Name
Relationship to you
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U.S. ADDRESS AND PHONE NUMBER OF POINT OF CONTACT
Street Address (line 1)
Street Address (line 2)
City
State
Phone Number
Zip Code
Email Address
FAMILY INFORMATION
Please provide the following information concerning your biological parents. If adopted, please provide the following information on your adoptive
parents.
Father's Full Name and Date of Birth
Surname
Given Names
Date of Birth (mm-dd-yyyy)
Year of Death
Is your father in the United
States?
Yes
No
Street Address (line 1)
City
Zip Code
Father's Status
Street Address (line 2)
State/Province
Country
Mother's Full Name and Date of Birth
Surname
Given Names
Date of Birth (mm-dd-yyyy)
Year of Death
Is your mother in the United
States?
Yes
No
Street Address (line 1)
City
Zip Code
Mother's Status
Street Address (line 2)
State/Province
Country
Do you have any immediate relatives, not including parents, in the United States?
Yes
No If yes please provide the following information below.
(Immediate relatives means fiancé/fiancée, spouse (husband/wife), child (son/daughter), or sibling (brother/sister)).
Surname
Given Names
Relatives Status
Relationship to You
Do you have any immediate relatives, not including parents, in the United States?
Surname
Yes
Given Names
Do you have any immediate relatives, not including parents, in the United States?
Surname
No If yes please provide the following information below
Relationship to You
Yes
Given Names
Relatives Status
No If yes please provide the following information below
Relationship to You
Relatives Status
FAMILY INFORMATION - SPOUSE
Do you have any former spouses?
Yes
No If yes, please provide former spouse information below
Surnames
Given Names
Date of Birth (mm-dd-yyyy)
City of Birth
Country/Region of Origin (nationality)
Number of Former Spouses
Date of Marriage (mm-dd-yyyy)
County/Region
Country/Region Marriage was Terminated
Date Marriage Ended (mm-dd-yyyy)
Explain how the marriage ended
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FIANCE/FIANCEE INFORMATION (If you are K-1 or K-3 applicant, please provide the following information)
Fiancé/Fiancée Full Name and Date of Birth
Surname
Given Names
Date of Birth (mm-dd-yyyy)
Occupation
Street Address (line 1)
City
Zip Code
Apt # (line 2)
State/Province
Country
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FAMILY INFORMATION - CHILDREN Please provide the following information if you are a k1, k3 applicant.
Do you have any children?
Surname
Yes
No If yes please provide information below
Given Name
Birth Date
(mm-dd-yyyy)
Birth Place
Will accompany you?
Will follow you?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
PRESENT WORK/EDUCATION/TRAINING INFORMATION
Provide the following information concerning your current employment or education.
Primary Occupation
Profession
Present Employer or School Name
Address of Employee or School
Street Address (line 1)
Street Address (line 2)
City
State/Province
Phone Number
Postal Zone/Zip Code
Monthly Income
Country Region
Briefly Describe Your Duties
Education Degrees, Licenses, or Alternative Credentials for Your Profession
PREVIOUS WORK/EDUCATION/TRAINING INFORMATION
Provide your employment information for the last five years that you were employed, if applicable. Do not list your current employment listed elsewhere
in this application.
Were you previously employed?
Yes
No If yes please provide the following information below
Employer Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Telephone Number
Job Title
Supervisor's Surname
Supervisor's Given Name
Employment Date From (mm-dd-yyyy)
Employment Date To (mm-dd-yyyy)
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Employer Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Telephone Number
Job Title
Supervisor's Surname
Supervisor's Given Name
Employment Date From (mm-dd-yyyy)
Employment Date To (mm-dd-yyyy)
Briefly Describe Your Duties
Employer Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Telephone Number
Job Title
Supervisor's Surname
Supervisor's Given Name
Employment Date From (mm-dd-yyyy)
Employment Date To (mm-dd-yyyy)
Briefly Describe Your Duties
Employer Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Telephone Number
Job Title
Supervisor's Surname
Supervisor's Given Name
Employment Date From (mm-dd-yyyy)
Employment Date To (mm-dd-yyyy)
Briefly Describe Your Duties
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PREVIOUS WORK/EDUCATION/TRAINING INFORMATION - continued
Briefly Describe Your Duties
Employer Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Telephone Number
Job Title
Supervisor's Surname
Supervisor's Given Name
Employment Date From (mm-dd-yyyy)
Employment Date To (mm-dd-yyyy)
Briefly Describe Your Duties
Employer Name
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Telephone Number
Job Title
Supervisor's Surname
Supervisor's Given Name
Employment Date From (mm-dd-yyyy)
Employment Date To (mm-dd-yyyy)
Briefly Describe Your Duties
Have you attended any educational institutions at a secondary level or above?
Yes
No If yes please provide the following information
below
Name of Institution
Choice of Study
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Date of Attendance From (mm-dd-yyyy)
Date of Attendance to (mm-dd-yyyy)
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Have you attended any educational institutions at a secondary level or above?
Yes
No
If yes please provide the following information
below.
Name of Institution
Choice of Study
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Date of Attendance From (mm-dd-yyyy)
Date of Attendance to (mm-dd-yyyy)
Name of Institution
Choice of Study
Street Address (line 1)
Street Address (line 2)
City
State/Province
Postal Zone/Zip Code
Country Region
Date of Attendance From (mm-dd-yyyy)
Date of Attendance to (mm-dd-yyyy)
ADDITIONAL INFORMATION
Do you belong to a clan or tribe?
Yes
No
If yes please provide the following information below.
Provide the languages you speak below.
Provide the countries you have traveled in the last five years below.
Have you belonged to, contributed to, or worked for any professional, social, or charitable organizations?
If yes please provide the names of organizations below.
Organization Names
Yes
Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experiences?
No
Yes
No
Explain
Have you ever served in the military?
Yes
No
If yes please provide the following information below.
Country/Region
Branch of Service
Rank/Position
Military Specialty
Date of Service From (mm-dd-yyyy)
Date of Service to (mm-dd-yyyy)
Have you ever served in, been a member of, or been involved with a paramilitary unit, rebel group, guerilla group, or insurgent organization?
Yes
No If yes explain below.
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Page 13 of 19
Please provide the following security and background information. Provide complete and accurate information to all questions that require
an explanation. 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). Are any of the following applicable to you? While a YES answer does not automatically
ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.
Do you have a communicable disease of public health significance? (Communicable diseases of public significance include cancroid, gonorrhea,
granuloma, inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as determined
by the Department of Health and Human Services.)
Yes
No
If yes explain below.
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?
Yes
No
If yes explain below.
Are you or have you ever been a drug abuser or addict?
Yes
No
If yes explain below.
Do you have documentation to establish that you have received vaccinations in accordance with U.S law?
Yes
No
If yes explain below.
Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar offense?
Yes
No
If yes explain below.
Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substance?
Yes
No
If yes explain below.
Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring
prostitutes within the past 10 years?
Yes
No
If yes explain below.
Have you ever been involved in, or do you seek to engage in, money laundering?
Yes
No
If yes explain below.
Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?
Yes
No
If yes explain below.
Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed, or conspired to commit a severe human trafficking
offense in the United States or outside the United States?
Yes
No
If yes explain below.
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 or
outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?
Yes
DS-0156
No
If yes explain below.
Page 14 of 19
Are you the spouse, son, or daughter of an individual who has been identified by the President of the United States as a person who plays a significant
role in a severe form of trafficking in persons and have you, with the the last five years, knowingly benefited from the trafficking activities?
Yes
No If yes explain below.
Are you the spouse, son or daughter of an individual who has violated any controlled substance trafficking law, and has knowingly benefited from the
trafficking in the past five years?
Yes
No If yes explain below.
Do you seek to engage in espionage, sabotage, export control violations or any other illegal activity in the United States?
Yes
No
If yes explain below.
Have you or do you intend to provide financial assistance or other support to terrorist or terrorist organizations?
Yes
No
If yes explain below.
Are you a member or representative of a terrorist organization?
Yes
No
If yes explain below.
Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing financial assistance or other support to
terrorists or terrorist organizations, in the last five years?
Yes
No If yes explain below.
Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
Yes
No
If yes explain below.
Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?
Yes
No
If yes explain below.
Have you ever committed, or tortured, incited, assisted, or otherwise participated in torture?
Yes
No
If yes explain below.
Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?
Yes
No
If yes explain below.
Have you ever engaged in the recruitment or the use of child soldiers?
Yes
No
If yes explain below.
Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious
freedom?
Yes
No If yes explain below.
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Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her
free choice or a man or a woman to undergo sterilization against his or her free will?
Yes
No If yes explain below.
Have you been ordered removed from the U.S. during the last five years?
Yes
No
If yes explain below.
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 fraud or
willful misrepresentation or other unlawful means?
Yes
No If yes explain below.
Are you subject to a civil penalty under INA 274C?
Yes
No
If yes explain below.
Have you been ordered removed from the U.S. for a second time within the last 20 years?
Yes
No
If yes explain below.
Have you ever been convicted of an aggravated felony and been order removed from the U.S.?
Yes
No
If yes explain below.
Have you ever been unlawfully present in the U.S. for more than 180 days (but no more than one year) and have voluntarily departed the U.S. within
the last three years?
Yes
No If yes explain below.
Have you ever been unlawfully present in the U.S. for more than one year in the aggregate at any time during the past ten years?
Yes
No
If yes explain below.
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?
Yes
No
If yes explain below.
Have you ever voted in the United States in violation of any law or regulation?
Yes
No
If yes explain below.
Have you ever renounced United States citizenship for the purposes of avoiding taxation?
Yes
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No
If yes explain below.
Page 16 of 19
Have you attended a public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the
school?
Yes
No If yes explain below.
Are you a former exchange visitor who has not yet fulfilled the two year foreign residence requirement?
Yes
No
If yes explain below.
Do you seek to enter the United States for purpose of performing skilled or unskilled labor but have not yet been certified by the Secretary of Labor?
Yes
No
If yes explain below.
Are you a graduate of a foreign medical school seeking to perform medical services in the United States but have not yet passed the National Board of
Medical Examiners examination or its equivalent?
Yes
No If yes explain below.
Are you a healthcare worker seeking to perform such work in the United States but have not yet received certification from the Commission on
Graduates of Foreign Nursing Schools or from an equivalent approved independent credentialing organization?
Yes
No If yes explain below.
Are you permanently ineligible for U.S. citizenship?
Yes
No
If yes explain below.
Have you ever departed the United States in order to evade military service during a time of war?
Yes
No
If yes explain below.
Are you coming to the U.S. to practice polygamy?
Yes
No
If yes explain below.
Has an immigration judge or the Board of Immigration Appeals ever determined that you had knowingly made a frivolous application for asylum?
Yes
No
If yes explain below.
Are you a member of or affiliated with the Communist or other totalitarian party?
Yes
No
If yes explain below.
Have you ever directly or indirectly assisted or supported any of the groups in Colombia known as the Revolutionary Armed Forces of Colombia
(FARC), National Liberation Army (ELN), or United Self-Defense Forces of Colombia (AUC)?
Yes
No If yes explain below.
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Have you ever through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation
to which a United States national had claim of ownership?
Yes
No If yes explain below.
Are you the spouse, minor child, or agent of an individual who has through abuse of governmental or political position converted for personal gain,
confiscated, or expropriated property in a foreign nation to which a United States national had claim of ownership?
Yes
No
If yes explain below.
Have you ever disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons
Convention?
Yes
No If yes explain below.
Are you the spouse, minor child, or agent of an individual who has disclosed or trafficked in confidential U.S. business information obtained in
connection with U.S. participation in the Chemical Weapons Convention?
Yes
No If yes explain below.
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PLEASE READ THE INFORMATION CAREFULLY BEFORE SIGNING AND SUBMITTING YOUR APPLICATION
The information that you have provided in your application and other information submitted with you application may be accessible to other government
agencies having statutory or other lawful authority to use such information, including for law enforcement and immigration law enforcement purposes.
The photograph that you provided with your application may be used for employment verification or other U.S. law purposes.
Applicant's Signature ___________________________________________________
I understand that I am required to submit my visa to the United States Immigration Officer at the place where I apply to enter the United States, and that
the possession of a visa does not entitle me to enter the United States if at that time I am found inadmissible under the immigration laws.
Applicant's Signature ___________________________________________________
I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may subject me to permanent
exclusion from the United States and, if I am admitted to the United States, may subject me to criminal prosecution and or/deportation.
Applicant's Signature ___________________________________________________
Nonimmigrant Fiancé(e) Applicant: I hereby certify that I am legally free to marry and intend to marry
a U.S. Citizen, within 90 days of my admission into the United States.
Applicant's Signature ___________________________________________________
I do solemnly swear or affirm that all statements which appear in this application have been made by me and are true and complete to best of my
knowledge and belief.
Applicant's Signature ___________________________________________________
Was this application prepared by another person on your behalf? If yes please have that person complete provide the information below
Application Prepared by
Relationship to Applicant
Address
Signature of Person Preparing Form ___________________________________________________
Date (mm-dd-yyyy)
Paperwork Reduction Act Statement
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including time required for searching existing
data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do
not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this
burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington,
DC 20522-2202.
Confidentiality Statement
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.
DS-0156
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| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |