4.Other First and Middle Names Used:

5.Sex:

6.Nationality:

7.Date of Birth (dd-month-yyyy):

8.Place of Birth: City /Country /State ,Province:

9.National Identification Number:

10.Father’s name:

11.Mother’s name:

12.Passport Number:

13.Place of Issuance:

14.Issuing Country:

15.Issuance Date (dd-month-yyyy):

16.Expiration Date (dd-month-yyyy):

20.Name of Present Employer or School:

22.Present Occupation (If retired, write "retired". If student, write "student".):

23.Business Phone Number:

24.Business Fax Number:

25.Mobile/Cell Number:

26.E-Mail Address:

27.Marital Status:

28.Spouse's Full Name (Even if divorced or separated. Include maiden name.):

29.Spouse's DOB (dd-month-yyyy):

30.Spouse’s Father Name?

31.Spouse’s Mother Name?

32.Do you have any children? If yes, please write name of children:

33.When Do You Intend To Arrive In The U.S.?

34.At What Address Will You Stay in The U.S.?

35.Name of Person in U.S. Who You Will Be Staying With or Visiting for Tourism or Business:

36.Telephone Numbers of Person in U.S. Who You Will Be Staying With or Visiting for Tourism or Business:

37.How Long Do You Intend To Stay in The U.S.?

38.What is The Purpose of Your Trip?

39.Who Will Pay For Your Trip?

40.Have You Ever Been in The U.S.?

(If yes, when and for how long?):

41.Have You Ever Been Issued a U.S. Visa?

(If yes, when, where and what type of visa?)

42.Have You Ever Been Refused a U.S. Visa?

(If yes, when, where and what type of visa?)

43.Do You Intend To Work in The U.S.?

44.Do You Intend To Study in The U.S.?

45.Names and Relationships of Persons Traveling With You:

46.Has Your U.S. Visa Ever Been Cancelled or Revoked:

47.Has Anyone Ever Filed an Immigrant Visa Petition on Your Behalf?

48.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.).

A. Husband/ Wife                                    B. Father/ Mother

C. Brother / Sister                                    D. Son/ Daughter

E. Fiance / Fiancee

50.List All Countries That Have Ever Issued You a Passport:

51.Have you ever lost a passport or had one stolen?

57.Do you have any specialized skills or training, including firearms, explosives, nuclear, biological, or chemical experience?

If yes, please explain:

59.Have you ever been in an armed conflict, either as a participant or victim?

60.List all educational institutions you attend or have attended. Include vocational institutions but not elementary schools.

61.Have you made specific travel arrangements?

If YES, please provide a complete itinerary for your travel, including arrival/departure dates, flight information, specific location you will visit, and a point of contact at each location.