USA APPLICATION FORM DS-160

Note: Wherever the applicant's details are

not applicable, please mention "does not
apply"
Preferred Date for Interview
Language Of Interview
(English/Marathi/Gujarati/Hindi) for
western zone
Place of Interview
Personal Information – 1
1.Surnames
2.Given Names
3.Have you ever used other names
(i.e., maiden, religious, professional, alias, etc.)?
If Yes the mention the
Name:
Surname:
4. Do you have a telecode that represents your
name? If Yes then provide – Surname & Name
5. Sex :Male/ Female
6. Marital Status : PLEASE SELECT FROM THE
BELOW
MARRIED
SINGLE
WIDOWED
DIVORCED
COMMON LAW MARRIAGE
CIVIL UNDOMESTIC PARTNERSHP
LEGALLY SEPARATED
OTHER
7. Date of Birth
8. City of Birth
9. State of Birth
10. Country of Birth
Personal Information – 2
11.Nationality
12.Do you hold or have you held a nationality other
than the one you have indicated above
13.U.S. Social Security Number (If applicable)
14.US Tax payer ID Number (If applicable)
Address And Phone Information
15. Home Address (Full add with Country, state and
area Pin code.)
16. Is your Mailing Address the same as your Home
Address? Yes / No:
This is the address to which your passport will be
sent if you qualify for a visa).
IF NO- Then enter the new address with complete
details – pin code
17. Primary No

Work Ph No

Secondary No

Mobile No
18.Have you used additional phone numbers in the
last five years ?
19.Email Address: (Mandatory to create a
profile)

Have you used additional email addresses in the last

five years?

20.Do you have a social media presence?

Select from the list below each social media
platform you have used within the last five years.
ASK.FM MYSPACE TWOO INSTAGRAM
DOUBAN PINTEREST VINE LINKEDIN
FACEBOOK QZONE VKONTAKTE (VK) TUMBLR
FLICKR REDDIT YOUKU TWITTER
GOOGLE+ SINA WEIBO YOUTUBE

(1)Social Media (2)Social Media

Provider/Platform: Provider/Platform:
Social Media Identifier: Social Media
(USER ID) Identifier: (USER ID)

(3)Social Media (4)Social Media

Provider/Platform: Provider/Platform:
Social Media Identifier: Social Media
(USER ID) Identifier: (USER ID)

(5)Social Media (6)Social Media

Provider/Platform: Provider/Platform:
Social Media Identifier: Social Media
(USER ID) Identifier: (USER ID)

Passport Information
21.Passport/Travel Document Type: Regular/ Official/ Diplomatic/ Others
Passport Number:
Place of Issue : Country
City
State
Passport Issue Date
Passport Expiry Date
Have you ever lost a passport or had one stolen?
If Yes :
Passport/Travel Document Number
Country/Authority that Issued Passport:
Explain
Travel Information

22. Are you the principal applicant?

PLEASE SELECT FROM THE BELOW

BUSINESS/CONFERENCE VISITOR (B1)
TOURIST/PERSONAL TRAVEL VISITOR (B2)
BUSINESS/PERSONAL TRAVEL (B1, B2)
BORDER CROSSING CARD/LASER VISA (BCC)
STUDENT/EXCHANGE VISA (F, J, M, Q)
OTHER
IF NO - Enter the name of the Principal Applicant,
Principal Applicant's Purpose of trip)

23. Have you made any specific travel plans? Yes / No

24.Intended Date of Arrival :

(Approx – Date of Travel with DD/MM/YY)

25. Arrival Flight if Known

26. Arrival city

27 Date of Departure from US

28.Departure flight
29. Departure City
30.Intended Length of Stay in U.S: (Approx –
Days/Month)
Locations you plan to visit :

31. Address Where You Will Stay in the U.S.

Hotel Complete Name,
Address, State with Pin Code Tel. No with std code.

32. Person/Entity Paying for Your Trip

PLEASE SELECT FROM THE BELOW

Self

Other Person (Name, Telephone Number and

relationship of person paying
for your trip)
Company/Organization (name, tel no. , relationship -
employer, others)

33. Is the address of the party paying for your trip

the same as your home
or mailing address? Yes / No
IF NO - Name, Telephone Number and Address
 TRAVEL COMPANION INFORMATION

Are there other persons traveling with you? : Yes / No -

Are you traveling as part of group / Organization? Yes / No -

If yes the specify the Group Name ;

If not traveling as a group then specify the: Name,

Telephone Number and
relationship of person of traveling with you.
PREVIOUS US TRAVEL INFORMATION

Have you ever been in the U.S.?

If Yes - Then required Previous Visa copy Yes / No

Provide information on your last five U.S.

visits –
Date of Arrival : Dd/mm/yy
Length of Stay: In days or months or years

INFO - If you are unsure about when you visited

the U.S., please provide
a best estimate
Do you or did you hold a U.S. Driver's License? If
Yes:
Drivers License No :
Issuing State :

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

(Last Visa issued date, visa number) If Yes

Are you applying for the same type of Visa? Yes / No

re you applying in the same country where the visa

above was issued & is
this country your principle country of residence?
If No please mention the country.
Have you been ten printed? Yes / No

Have your US visa been lost / Stolen? Yes / No

Year visa was lost or stolen:
Have your US visa been ever cancelled / Revoked?
Yes/ 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? If yes please Explain.
Has anyone ever filed an immigrant petition on your
behalf with the United States Citizenship and
Immigration Services?
US POINT OF CONTACT
Name of Contact Person in the United States
Organization Name in US (if applicable)
Relationship: PLEASE SELECT FROM THE
BELOW
RELATIVE
SPOUSE
FRIEND
BUSINESS ASSOCIATE
EMPLOYER
SCHOOL OFFICIAL
OTHER
Address: Complete address with pin code & state.
Hotel Address (If No Relatives in US)
Phone Number of Point of Contact
(MANDATORILY REQ)
Email Address
FAMILY INFO (RELATIVES)
Father's Full Name
Name :
Surname :
Fathers Date of Birth: dd/mm/yy
Is your FATHER in the U.S.? Yes / No
Mother's Full Name
Name:
Surname:
Mothers Date of Birth : dd/mm/yy
Is your mother in the U.S.? Yes / No
Do you have any immediate relatives, not
including parents, in the United States?
IF YES –
Name :
Surname :
Status In US : Please select from the below:
Relationship Status
U.S. CITIZEN
U.S. LEGAL PERMANENT RESIDENT (LPR)
NONIMMIGRANT
OTHER / DON'T KNOW
Relationship to You: Please select from the below
SIBLING
SPOUSE
FIANCÉ/FIANCÉE
CHILD
Do you have any other relatives in the United States? : Yes / No
FAMILY INFO (SPOUSE)
SPOUSE FULL NAME(If applicable)
Name :
Surname :
SPOUSE DOB: dd/mm/yy
SPOUSE PLACE OF BIRTH:
NATIONALITY:
ADDRESS: If it is not same as your home address
then mention it.
Divorcee Information:

1. Number of Former Spouses

2. Date of Marriage: (Format: DD-MMM-YYYY)

3. Date Marriage Ended : (Format: DD-MMM-YYYY)

4. How the Marriage Ended : Explain

5. Country Marriage was Terminated : Country Name

WORK INFO: PRESENT WORK / EDUCATION / TRAINING INFO.
Primary Occupation: Service , Studying or specify
other
Present Employer Organization / School or
college Name:
Address: With pin code, state.

Date of Joining:
Monthly Income in Local Currency :
(Salaried/Business/Professional etc)
Briefly describe your duties:
Were you previously employed? IF YES –
(Provide at least last 2)
Please specify the Organization Name:
Address:
Phone No:
Designation:
Date of Joining:
Supervisor's Name
Surname:
Employment Date (From and To): MM/YY
Describe your duties:
EDUCATION INFO : (In Descending order)
Have you attended any educational institutions other
than elementary schools? If Yes:
Name of Institute/ College:
Address:
Course of Study:
Attended Date - From and To (MM/YY)
Name of Institute/ College:
Address:
Course of Study:
Attended Date - From and To (MM/YY)
Name of Institute/ College:
Address:
Course of Study:
Attended Date - From and To (MM/YY)
Do you belong to a clan or tribe? Clan or Tribe name:
Provide a List of Languages You Speak:
Have you traveled to any countries within the last five
years?
If Yes Specify all the countries visited in last five
years:
Country Name’s: (please specify the Countries
name travelled in Schengen & Europe)
Have you belonged to, contributed to, or worked for
any professional, social, or charitable organization? –
(Organization / Trust Name)
Do you have any specialized skills or training, such as
firearms, explosives, Nuclear, biological, or chemical
experience? Have you ever
served in the military? If Yes.
Date of Service from & to
Country & Branch of Service.
Rank / Position & Military specialty
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?
SECURITY AND BACKGROUND MEDICAL AND HEALTH
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 abuser or
addict?
CRIMINAL INFO
Have you 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?
Have you ever committed or conspired to commit a
human trafficking offense in the United States or
outside the United States?
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? SECURITY INFO

Do you seek to engage in espionage, sabotage, export

control violations, or any other illegal in the USA
Do you seek to engage in terrorist 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 terrorist 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 of violence?
Have you ever engaged in the recruitment or the use
of the child soldiers?
Have you, while serving as a government official,
been responsible for or directly carried out, at any
time, particularly severe violations of religious
freedom?
Have you ever been directly involved in the
establishment or enforcement of the 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?
Have you ever been directly involved in the coercive
transplantation of human organs or bodily tissue?
IMMIGRATION LAW VIOLATION
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?
MISCELLANIOUS INFO
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?
Did anyone assist you in filling out this
application?
Organization Name
Address
Relationship
declare that the information furnished on this form is true and complete to the best of my
Knowledge & belief
Date & Signature
Note: US online visa application will not be
processed unless signed by the applicant.