Fomulario DS160

Online Nonimmigrant Visa Application (DS-160)
Application - Sensitive But Unclassified(SBU)
We do not need a printed copy of your application at any point during your interview process. Only print this
application if you want a copy for your own records. If you print your application, please keep it secure.
Photo Provided:
Confirmation Number:
Personal, Address, Phone, and Passport/Travel Document Information

Name Provided:
Full Name in Native Language:
Other Names Used:
Telecode Name Used:
Sex:
Marital Status:
Date of Birth:
Place of Birth:
Country/Region of Origin (Nationality):
Do you hold or have you held any nationality other than the one
indicated above on nationality?
Are you a permanent resident of a country/region other than your

country/region of origin (nationality) above?
National Identification Number:
U.S. Social Security Number:
U.S. Taxpayer ID Number:
Home Address:
City: SANTO DOMINGO
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Same Mailing Address?
Primary Phone Number:
Secondary Phone Number:
Work Phone Number:
Do you have any additional phone numbers?
Email Address:
Do you have any additional email addresses?
Do you have a social media presence?
Social Media Platform: (1):
Social Media Identifier:
Do you have any additional social media presence?
Passport/Travel Document Type:
Passport/Travel Document Number:
Passport Book Number:
Country/Authority that Issued Passport/Travel Document:
City Where Issued:
State/Province Where Issued: SANTO DOMINGO Country/Region Where Issued:
Issuance Date:
Expiration Date:
Have you ever lost a passport or had one stolen?
Travel Information
The List of Purposes of Trip to the U.S.
Purpose of Trip to the U.S. (1):
Specify:
Have you made specific travel plans? NO
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:
Are there other persons traveling with you?
Have you ever been in the U.S.?
Date Arrived (1):
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?
Has your U.S. Visa ever been cancelled or revoked?
Have you ever been refused a U.S. Visa, or been refused admission to
the United States, or withdrawn your application for admission at the
port of entry?
Has anyone ever filed an immigrant petition on your behalf with the
United States Citizenship and Immigration Services?
U.S. Contact Information

Contact Person Name in the U.S.:
Organization Name in the U.S.:
Relationship to You: RELATIVE
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: PAULA
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.?
Relative Name (1):
Relationship to you: SIBLING
Status:
Work/Education/Training Information
Primary Occupation:
Were you previously employed?
Employer Name (1):
Employer Address:
City:
State/Province:
Postal Zone/Zip Code:
Country/Region:
Telephone Number:
Job Title:
Supervisor's Surname:
Supervisor's Given Name:
Employment Date From:
Employment Date To:
Briefly describe your duties:
Have you attended any educational institutions at a secondary level or

above?
Name of Institution (1):
Address of Institution:
City:
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Course of Study:
Date of Attendance From:
Date of Attendance To:
Do you belong to a clan or tribe?
Provide a List of Languages You Speak:
Language Name (1):
Have you traveled to any countries/regions within the last five years?
Have you belonged to, contributed to, or worked for any professional,
social, or charitable organization?
Do you have any specialized skills or training, such as firearms,

explosives, nuclear, biological, or chemical experience?
Have you ever served in the military?
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?

Fomulario DS160

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Fomulario DS160

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Online Nonimmigrant Visa Application (DS-160)

Application - Sensitive But Unclassified(SBU)

Personal, Address, Phone, and Passport/Travel Document Information

Full Name in Native Language:

Other Names Used:

Telecode Name Used:

Country/Region of Origin (Nationality):

Are you a permanent resident of a country/region other than your

National Identification Number:

U.S. Social Security Number:

U.S. Taxpayer ID Number:

City: SANTO DOMINGO

Postal Zone/ZIP Code:

Primary Phone Number:

Secondary Phone Number:

Work Phone Number:

Do you have any additional phone numbers?

Do you have any additional email addresses?

Do you have a social media presence?

Social Media Platform: (1):

Social Media Identifier:

Do you have any additional social media presence?

Passport/Travel Document Type:

Passport/Travel Document Number:

Passport Book Number:

Country/Authority that Issued Passport/Travel Document:

City Where Issued:

State/Province Where Issued: SANTO DOMINGO Country/Region Where Issued:

Have you ever lost a passport or had one stolen?

Purpose of Trip to the U.S. (1):

Have you made specific travel plans? NO

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:

Are there other persons traveling with you?

Have you ever been in the U.S.?

Date Arrived (1):

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:

Are you applying for the same type of visa?

Have you been ten-printed?

Has your U.S. Visa ever been lost or stolen?

Has your U.S. Visa ever been cancelled or revoked?

U.S. Contact Information

Organization Name in the U.S.:

Relationship to You: RELATIVE

U.S. Contact Address:

Father's Given Names:

Father's Date of Birth:

Is your father in the U.S.?

Mother's Given Names: PAULA

Mother's Date of Birth:

Is your mother in the U.S.?

Do you have any immediate relatives, not including parents in the

Relative Name (1):

Relationship to you: SIBLING

Were you previously employed?