Image of the State SealU.S. Department of State
NONIMMIGRANT VISA APPLICATION

Approved OMB 1405-0018
Expires 09/30/2007
Estimated Burden 1 hour
See Page 2
PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM


City
Country
State/Province
DO NOT WRITE IN THIS SPACE


daymonthyear

daymonthyear





daymonthyear
City
Country
State/Province


Male
Female


Street Address Line 1

Street Address Line 2

City

State/Province

Postal Code

Country
16.






Married Single (Never Married)
Widowed Divorced Separated

daymonthyear
Name:Address:

daymonthyear


Street Address Line 1

Street Address Line 2

City

State/Province

Postal Code
Barcode

Name
Home Phone
Business Phone
Cell Phone

DO NOT WRITE IN THIS SPACE

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50mm X 50 mm
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PHOTO
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Staple or glue photo here.
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Yes No
WHEN?daymonthyear
 
FOR HOW LONG?
DS-156
02-2003
PREVIOUS EDITIONS OBSOLETEPage 1 of 2
 
Yes No
WHEN?daymonthyear
 
WHERE?
WHAT TYPE OF VISA?
Yes No
WHEN?daymonthyear
 
WHERE?
WHAT TYPE OF VISA?
Yes No
(If YES, give the name and complete address of U.S. employer.)
Yes No
(If YES, give the name and complete address of the school.)


Yes No   If Yes, Who?
37. Are Any of The Following Persons in The U.S., or Do They Have U.S. Legal Permanent Residence or U.S. Citizenship?
Mark YES or NO and indicate that person's status in the U.S. (i.e., U.S. legal permanent resident, U.S. citizen, visiting, studying, working, etc.).
Yes No
   Yes No
   Yes No
Yes No
  Yes No
 
38. IMPORTANT: ALL APPLICANTS MUST READ AND CHECK THE APPROPRIATE BOX FOR EACH ITEM.
A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Is any of the following applicable to you?
  • Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty or other similar legal action? Have you ever unlawfully distributed or sold a controlled substance(drug), or been a prostitute or procurer for prostitutes?
Yes No
  • Have you ever been refused admission to the U.S., or been the subject of a deportation hearing or sought to obtain or assist others to obtain a visa, entry into the U.S., or any other U.S. immigration benefit by fraud or willful misrepresentation or other unlawful means? Have you attended a U.S. public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school?
Yes No
  • Do you seek to enter the United States to engage in export control violations, subversive or terrorist activities, or any other unlawful purpose? Are you a member or representative of a terrorist organization as currently designated by the U.S. Secretary of State? Have you ever participated in persecutions directed by the Nazi government of Germany; or have you ever participated in genocide?
Yes No
  • Have you ever violated the terms of a U.S. visa, or been unlawfully present in, or deported from, the United States?
Yes No
  • 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, voted in the United States in violation of any law or regulation, or renounced U.S. citizenship for the purpose of avoiding taxation?
Yes No
  • Have you ever been afflicted with a communicable disease of public health significance or a dangerous physical or mental disorder, or ever been a drug abuser or addict?
Yes No
While a YES answer does not automatically signify ineligibility for a visa, if you answered YES you may be required to personally appear before a consular officer.
Was this Application Prepared by Another Person on Your Behalf?      Yes No
(If answer is YES, then have that person complete item 40.)
Application Prepared By:
NAME:      Relationship to Applicant:
ADDRESS:

Signature of Person Preparing Form:____________________________________________  DATE (dd-month-yyyy)__________________________

41. I certify that I have read and understood all the questions set forth in this application and the answers I have furnished on this form are true and correct to the best of my knowledge and belief. I understand that any false or misleading statement may result in the permanent refusal of a visa or denial of entry into the United States. I understand that possession of a visa does not automatically entitle the bearer to enter the United States of America upon arrival at a port of entry if he or she is found inadmissible.

APPLICANT'S SIGNATURE____________________________________________   DATE (dd-month-yyyy) ___________________________

Privacy and Paperwork Reduction Act Statements

INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation, amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be made available to a court which certifies that the information contained in such records is needed in a case pending before the court.

Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. You do not have to provide the information unless this collection displays a currently valid OMB number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State, A/RPS/DIR, Washington, DC 20520.
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Failure to click on the Continue button will result in an incorrectly formatted application form. It may take several minutes to generate the application form. Please do not click on the Continue button multiple times.

 

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