DS160签证表 美国签证申请表ds160

Application -

Sensitive But Unclassified(SBU)

Photo Provided:

Confirmation Number确认号:

Personal, Address, Phone, and PassportInformation

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. Social Security Number:

U.S. Taxpayer ID Number:

Home Address:

City:

State/Province:

Postal Zone/ZIP Code:

Country:

Same Mailing Address?

Mailing Address:

City:

State/Province:

Postal Zone/ZIP Code:

Country:

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:

Country Where Issued:

Issuance Date:

Expiration Date:

Have you ever lost a passport or had onestolen?

TravelInformation

Principal Applicant?

▲

Purpose of Your Trip toU.S.

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 tripthe 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.?

Do you or did you hold a U.S. Driver's License?

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

Have you ever been refused a U.S. Visa, beenrefused admission to the United States, or withdrawn yourapplication for admission at the point of entry?

U.S. ContactInformation

Contact Person Name in the U.S.:

Organization Name in the U.S.:

Relationship to You:

U.S. Contact Address:

Phone Number:

Email Address:

FamilyInformation

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 includingparents in the U.S.?

Do you have any other relatives in the UnitedStates?

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:

Security and Background Information安全与背景：医疗与健康信息

Do you have a communicable disease of public healthsignificance such as tuberculosis (TB)?

NO

Do you have a mental or physical disorder thatposes or is likely to pose a threat to the safety or welfare ofyourself or others?

NO

Are you or have you ever been a drug abuser oraddict?

NO

Have you ever been arrested or convicted for anyoffense or crime, even though subject of a pardon, amnesty, orother similar action?

NO

Have you ever violated, or engaged in a conspiracyto violate, any law relating to controlled substances?

NO

Are you coming to the United States to engage inprostitution or unlawful commercialized vice or have you beenengaged in prostitution or procuring prostitutes within the past 10years?

NO

Have you ever been involved in, or do you seek toengage in, money laundering?

NO

Do you seek to engage in espionage, sabotage,export control violations, or any other illegal activity while inthe United States?

NO

Do you seek to engage in terrorist activities whilein the United States or have you ever engaged in terroristactivities?

NO

Have you ever or do you intend to provide financialassistance or other support to terrorists or terroristorganizations?

NO

Are you a member or representative of a terroristorganization?

NO

Have you ever ordered, incited, committed,assisted, or otherwise participated in genocide?

NO

Have you ever committed, ordered, incited,assisted, or otherwise participated in torture?

NO

Have you committed, ordered, incited, assisted, orotherwise participated in extrajudicial killings, politicalkillings, or other acts of violence?

NO

Have you, while serving as a government official,been responsible for or directly carried out, at any time,particularly severe violations of religious freedom?

NO

Have you ever been the subject of a removal ordeportation hearing?

NO

Have you ever sought to obtain or assist others toobtain a visa, entry into the United States, or any other UnitedStates immigration benefit by fraud or willful misrepresentation orother unlawful means?

NO

Have you failed to attend a hearing on removabilityor inadmissibility within the last five years?

NO

Have you ever been unlawfully present, overstayedthe amount of time granted by an immigration official or otherwiseviolated the terms of a U.S. visa?

NO

Have you ever withheld custody of a U.S. citizenchild outside the United States from a person granted legal custodyby a U.S. court?

NO

Have you voted in the United States in violation ofany law or regulation?

NO

Have you ever renounced United States citizenshipfor the purpose of avoiding taxation?

NO

Have you attended a public elementary school onstudent (F) status or a public secondary school after November 30,1996 without reimbursing the school?

NO

LocationInformation递交申请的地点

Current Location:

Preparer of Application:

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