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Us Visa Blank Form

This document contains an application for a US visa. It includes biographical information such as the applicant's name, date of birth, passport details, contact information, family details, education and employment history. It also asks questions about the applicant's previous travel and whether they have ever been refused a visa. The purpose is to gather information to determine eligibility and assess any risks regarding the entry of the applicant into the US.

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Archit Bhardwaj
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© © All Rights Reserved
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424 views4 pages

Us Visa Blank Form

This document contains an application for a US visa. It includes biographical information such as the applicant's name, date of birth, passport details, contact information, family details, education and employment history. It also asks questions about the applicant's previous travel and whether they have ever been refused a visa. The purpose is to gather information to determine eligibility and assess any risks regarding the entry of the applicant into the US.

Uploaded by

Archit Bhardwaj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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US VISA APPLICATION FORM DS-160

Name Archit
Surname Bhardwaj
Other Names Used:
Sex: Male
Marital Status: Single
Date of Birth: 28.03.1993
Place of Birth: Udaipur
Nationality: Indian

Home Address: S-2 Gokul Krishna II Aditya Vihar Gandhi Path Vaishali Nagar
City: Jaipur
State/Province: Rajasthan
Postal Zone/ZIP Code: 302021
Country: India
Mailing Address: S-2 Gokul Krishna II Aditya Vihar Gandhi Path Vaishali Nagar
City: Jaipur
State/Province: Rajasthan
Postal Zone/ZIP Code: 302021
Country: India
Home Phone Number: 9829044274
Work Phone Number: 7568500274
Work Fax Number:
Mobile/Cell Phone Number: 9680878074
Email Address: architbhardwaj@live.com

Passport Number: K0175303


Passport Book Number:
Country/Authority that Issued Passport: India
City Where Issued: Jaipur
State/Province Where Issued: Rajasthan
Country Where Issued: India
Issuance Date: 30/09/2011
Expiration Date: 29/09/2021
Have you ever lost a passport or had one stolen? No

Purpose of Your Trip to U.S.


Specific Travel Plan?
Intended Date of Arrival:
Intended Length of Stay in U.S.:
Address where you will stay in the U.S.:

Person/Entity Paying for Your Trip:


Name of Company/Organization Paying for Trip:
Telephone:
Relationship to You:

Is the address of the party paying for your trip the same
as your Home or Mailing Address?
Payee Address:
City:
State/Province:
Postal Zone/ZIP Code:
Other Persons Traveling with You:

Have you ever been in the U.S.?


If yes please mention Travel Date of Arrival (1)

Have you ever been issued a U.S. Visa? Yes


Date Last Visa was Issued: 10-Jan-13
Visa Number: F8818169
Are you applying for the same type of visa? YES

Are you applying in the same country where the visa


above is issued and is this country your principal country
of residence? YES
Have you been ten-printed?
Has your U.S. Visa ever been lost or stolen? NO

Has your U.S. Visa ever been cancelled or revoked? NO

Have you ever been refused a U.S. Visa, been refused


admission to the United States, or withdrawn your
application for admission at the point of entry? NO

Contact Person Name in the U.S.:


Organization Name in the U.S.:
Relationship to You:
U.S. Contact Address:
Phone Number:
Email Address:

Father's Surnames: Bhardwaj


Father's Given Names: Veenu
Father's Date of Birth: 02.09.1962
Is your father in the U.S.? No

Mother's Surnames: Bhardwaj


Mother's Given Names: Neelam
Mother's Date of Birth: 04.03.1971
Is your mother in the U.S.? No
Do you have any immediate relatives, not including
parents in the U.S.? No

Spouse's Full Name:


Spouse's Date of Birth:
Spouse's Nationality:
Spouse's City of Birth:
Spouse's Country of Birth:
Spouse’s Address:

Primary Occupation:
Present Employer or School Name:
Address:
City:
Postal Zone/Zip Code:
Country:
Monthly Salary in Local Currency (if employed):
Briefly Describe your Duties:

Were you previously employed?


Employer Name (1):
Employer Address:
City:
State/Province:
Postal Zone/Zip Code:
Country:
Telephone Number:
Job Title:
Supervisor's Name:
Employment Date From:
Employment Date To:
Briefly describe your duties:

Have you attended any educational institutions other


than elementary schools? If yes Name of the Colleage /
Institution International Maritime Institute
address 13, Surajpur Kasna Rd, Knowledge Park I Greater Noida
course of study Diploma in Nautical Science
From: 01.08.2011
To: 20.07.2012

Do you belong to a clan or tribe? No

Languages known Hindi


English
Have you traveled to any countries within the last five
years? Yes
IF YES GIVE COUNTRY NAMES Singapore, South Korea, Indonesia

Have you belonged to, contributed to, or worked for any


professional, social, or charitable organization? No

Do you have any specialized skills or training, including


firearms, explosives, nuclear, biological, or chemical
experience? No
Have you ever served in the military? No

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? No

Specific job title aboard aircraft or vessel: Second Officer


Name of company that owns the aircraft or vessel you
will be working on:
Company telephone number:
Did you acquire your position using a
recruiting/manning/crewing agency?
Are you serving aboard a seagoing ship or vessel?
Seagoing Ship/Vessel Name:
Seagoing Ship/Vessel Identification Number:
Current wages in INR

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