FORMATO DS-160

ÚNICAMENTE PARA REVISIÓN

Name Provided:
Full Name in Native Language:
Other Names Used:
Sex:
Marital Status:
Date of Birth:
Place of Birth:
Nationality:
Other Nationalities:
National Identification Number:
U.S. Taxpayer ID Number:
Home Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country:
Same Mailing Address?
Home Phone Number:
Work Phone Number:
Work Fax Number:
Mobile/Cell Phone Number:
Email Address:
Passport Number:
Passport Book Number:
Country/Authority that Issued
Passport:
City Where Issued:
State/province Where Issued:
Country Where Issued:
Issuance Date:
Expiration Date:
Have You ever lost a passport or had
one stolen?
Travel Information
Principal Applicant?
*Purpose of Your Trip to U.S.
Purpose (1):
Specific Travel Plan?
Intended Date of Arrival:
Intended Length of Stay in U.S.:

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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
you trip the same as your Home or
Mailing Address?
Paying Address:
City
State/Province:
Postal Zone/ZIP Code:
Country:
Other persons traveling with you:
*Have you ever been in the U.S.?
Previous U.S. Visits in the last 5
years:
Travel Date of Arrival (1):
Length of Stay:
Travel Date of Arrival (2):
Length of Stay:
Do you or did you hold a U.S.
Driver’s License?
*Have you ever been issued a U.S.
Visa?
Date Last Visa was Issued:
Visa Number
Are you applying for the same type of
visa?
Are you Applying in the same
country where the visa above is
issued and is this country your
principal country of residence?
Have you been ten-printed?
Has Your U.S. Visa ever been lost or
stolen?
Year visa was lost or stolen:
Has your U.S. Visa ever been
cancelled or Revoked?
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United States, or withdrawn your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?
U.S. Contact Information

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

Family Information
Father´s Surnames:
Father´s Given Names:
Father´s Date of Birth:
Is your father in the U.S.?
Mother´s Surnames:
Mother´s Given Names:
Mother´s Date of Birth:
Is your mother in the U.S.?
Do you have any immediate relatives,
not Including parents in the U.S.?
Do you have any other relatives in the
United States?
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:
Work/ Education/ Training
Information
Primary Occupation:
Present Employer or School Name:
Address:
City:
State/Province:
Postal Zone/Zip Code:
Country:
Month Salary in Local Currency:
Briefly Describe your Duties:
Were you previously employed?
*Have you attended any educational
Institutions other than elementary
schools?
Name of Institution (1):
Address of Institution:
City:
State/Province

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Postal Zone/ZIP Code:
Country:
Course of Study:
Date of Study:
Date of Attendance From:
Date of Attendance To:
Do you belong to a clan or tribe?
*Have you traveled to any countries
within the Last five years?
Country Visited (1):
Country Visited (2):
Country Visited (3):
Country Visited (4):
Have you belonged to, contributed to,
or worked For any professional,
social, or charitable Organization?
Security and Background
Information
Do you have a communicable disease
of public Health significance such as
tuberculosis (TB)?
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?
Are you or have you ever been a drug
abuse or addict?
Have your ever been arrested or
convicted for any Offense or crime,
even though subject of a Pardon,
amnesty, or other, similar action?
Have you ever violated, or engaged in
a Conspiracy to violate, any law
relating to Controlled substances?
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?
Have you ever been involved in, or do
you seek to Engage in, money
laundering?
Do you seek to engage in espionage,
sabotage, export control violations, or
any other illegal Activity while in the
United States?
Do you seek to engage in terrorist

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activities while in the United States?
Or have you ever engaged in terrorist
activities?
Have you ever or do you intend to
provide Financial assistance or other
support to terrorists or terrorists
organizations?
Are you a member or representative
of a terrorist Organization?
Have you ever ordered, incited,
committed, assisted, or otherwise
participated in genocide?
Have you ever committed, ordered,
incited, Assisted, or otherwise
participated in torture?
Have you committed, ordered,
incited, assisted, or otherwise
participated in extrajudicial killings,
Political killings, or other acts or
violence?
Have you, while serving as a
government official, been responsible
for or directly carried out, at any time,
particularly severe violations or
religious Freedom?
Have you ever been the subject or a
removal or Deportation hearing?
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?
Have you failed to attend a hearing on
Removability or inadmissibility
within the last five Years?
Have you ever been unlawfully
present, overstayed the amount of
time granted by an Immigration
official or otherwise violated the
Terms of a U.S. visa?
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?
Have you voted in the United States
in violation of Any law or regulation?
Have you ever renounced United
States Citizenship for the purpose of
avoiding taxation?

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Have you attended a public
elementary school on Student (F)
status or a public secondary school
after November 30, 1996 without
reimbursing the School?
Location Information
Current Location:
Preparer of Application:
Did anyone assist you in filling out
this Application?