Visa Application Questionnaire

VISA APPLICATION QUESTIONNAIRE

1) First Name

Middle Name

Surname Name (last name)

2) Month of Birth

Your Day of birth

Your Year of Birth

3) Phone/Mobile Number

4) Age

5) City of Birth

6) City, Provience and Country of Birth

City

Province

Country

7) Nationality ( If dual national, give both )

Country

Dual National

Yes

Country

8) Gender

Male

Female

Other

9) Marital status

Married

Unmarried

10) Address in U.S where you intended to live

11) Address in the U.S where you want your green card to mail

12) Present occupation

13) Your Present Address

Address

City

Zip Code

Country

14) Name all your social media accounts

Name use on the accounts

15) Name all your social media accounts 2

Name use on the accounts 2

15) Name all your social media accounts 3

Name use on the accounts 3

15) Name all your social media accounts 4

Name use on the accounts 4

15) Name all your social media accounts 4

Name use on the accounts 4

15) Your Spouse's Maiden Or Family Name

Family Name

First Name

Middle Name

16) Date of birth of spouse

Month

Date

Year

17) Place of birth of spouse

18) Spouse's occupation

19) Date of Marriage

Month

Date

Year

20) Address of Marriage

Address

City

State

Zip Code

Country

21) Father's Family name

Family name

First Name

Middle Name

22) Father's Date of birth

Month

Day

Year

23) Father's Place of birth

24) Do you have a US social security number?

If father is deceased give the date of deceased as follow (mm/dd/year)

26) Father's current address ( If Deceased give year of death )

Address Line 1

Apartment/building/Floor/Unit No

City

State

Zip Code

Country

27) Year of death

28) Mother's Maiden Name

29) Mother's date of birth

Month

Day

Year

30) Mother's Place of birth

If your mother is deceased give the date of deceased as follow (mm/dd/year)

31) Mother's current address ( If Deceased give year of death )

Address Line 1

Apartment/building/Floor/Unit No

City

State

Zip Code

Country

32) Year of death

33) List names, dates of birth, place of birth and addresses of all children ( even if they are adults )

Name Of Childs

Date of birth of Child

First Name

Middle Name

Last Name

Month

Day

Year

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

Place of birth

Children's ( Address)

34) LIST BELOW ALL PLACES YOU HAVE LIVED FOR AT LEAST SIX MONTHS SINCE REACHING THE AGE OF 16

CITY OR TOWN

PROVINCE

Country

Year

CITY OR TOWN

PROVINCE

Country

Year

CITY OR TOWN

PROVINCE

Country

Year

CITY OR TOWN

PROVINCE

Country

Year

CITY OR TOWN

PROVINCE

Country

Year

CITY OR TOWN

PROVINCE

Country

Year

CITY OR TOWN

PROVINCE

Country

Year

CITY OR TOWN

PROVINCE

Country

Year

FROM

Month

Day

Year

Month

Day

Year

35) LIST BELOW ALL PERSONS WHO WILL ACCOMPANY YOU TO THE UNITED STATE

First Name

Middle Name

Surname

First Name

Middle Name

Surname

First Name

Middle Name

Surname

First Name

Middle Name

Surname

34) LIST BELOW ALL PERSON WHO WILL FOLLOW YOU TO THE UNITED STATES AT A LATER DATE

Date

First Name

Middle Name

Surname

Month

Day

Year

Month

Day

Year

35) LIST BELOW ALL EMPLOYMENT FOR THE LAST 10 YEARS

EMPLOYER

ADDRESS

JOB TITLE

PHONE NUMBER

START DATE

END DATE

Month

Day

Year

Month

Day

Year

36) IN WHAT OCCUPATION DO YOU INTEND TO WORK IN THE UNITED STATE?

37) LIST BELOW ALL EDUCATIONAL INSTITUTIONS YOU HAVE ATTENDED

From

SCHOOL NAME

ADDRESS

Month

Year

Month

Year

COURSE OF STUDY

DEGREE/DIPLOMA

38) PREVIOUS MILITARY SERVICE

DATE OF SERVICE

Yes

POSITION OR RANK

MILITARY OCCUPATION

DATES OF SERVICE

39) LIST DATES OF ALL PREVIOUS VISITS TO THE UNITED STATES; GIVE TYPE OF VISA, GIVE DHS “A” IF ANY

DATE ARRIVED

DATE DEPART

Month

Day

Year

Month

Day

Year

DATE VISA ISSUED

LENGTH OF STAY

VISA NUMBER

Month

Day

Year

40) HAVE YOU EVER BEEN CHARGED OR CONVICTED OF ANY OFFENCE OR CRIME?

PLEASE EXPLAIN

Yes

Description

41) HAVE YOU EVER BEEN REFUSED ADMISSION TO THE UNITED STATES AT A PORT OF ENTRY? (IF YES, PLEASE EXPLAIN)

EXPLAIN

Yes

Description

42) HAVE YOU EVER USED OTHER NAMES (MAIDEN, RELIGIOUS, PROFESSIONAL, ALIS)

Yes

First Name

Middle Name

Surname

First Name

Middle Name

Surname

First Name

Middle Name

Surname

43) PASSPORT NUMBER

44) DATE PASSPORT WAS ISSUED

Month

Day

Year

45) DATE PASSPORT EXPIRED

Month

Day

Year

46) HAVE YOU EVER BEEN MARRIED

Month

Day

Year

47) DATE OF MARRIAGE

Month

Day

Year

48) HOW WAS YOUR MARRIAGE ENDED (DIVORCE, DEATH ETC. )

49) HAVE YOU EVER HAVE AN ALIAN REGISTRATION NUMBER

50) HAVE ANY OF YOUR U.S. VISA BEEN CANCELLED OR REVOKED

51) HAVE YOU EVER REFUSED A U.S. VISA OR WITHDRAWN YOUR APPLICATION FOR ADMISSION AT THE PORT OF ENTRY IF YES, EXPLAIN:

Yes

EXPLAIN

52) HAVE YOU EVER BEEN UNLAWFULLY PRESENT IN THE U.S. FOR MORE THAN ONE YEAR FOR THE LAST ONE YEAR

List below all previous marriages

Full name 1

Date of birth

Surname

First Name

Month

Day

Year

Date of marriage

Month

Day

Year

How marriage was end

Full name 2

Date of birth

Surname

First Name

Month

Day

Year

Date of marriage

Month

Day

Year

How marriage was end

Full name 3

Date of birth

Surname

First Name

Month

Day

Year

Date of marriage

Month

Day

Year

How marriage was end

Date / Time

COMMITTED TO ASSISTING

THE JOURNEY

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Visa Application Questionnaire

VISA APPLICATION QUESTIONNAIRE

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