Approved OMB 1405-0018 Expires 06/30/2014 Estimated Burden 1 hour See Page 2 U.S. Department of State NONIMMIGRANT VISA APPLICATION PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM DO NOT WRITE IN THIS SPACE 2. Place of Issuance: B-1/B-2 MAX B-1 MAX B-2 MAX City Country State/Province 1. Passport Number Other MAX Visa Classification 4. Issuance Date (dd-mmm-yyyy) 3. Issuing Country 5. Expiration Date (dd-mmm-yyyy) Mult or Number of Applications Months 6. Surnames (As in Passport) Validity Issued/Refused By On 7. First and Middle Names (As in Passport) Under SEC. 8. Other Surnames Used (Maiden, Religious, Professional, Aliases) 214(b) 221(g) Other INA Reviewed By 9. Other First and Middle Names Used 11. Place of Birth City 13. Sex Male 10. Date of Birth (dd-mmm-yyyy) 12. Nationality State/Province Country 14. National Identification Number 15. Home Address (Include Apartment Number, Street, City, State or Province, Postal Zone and Country) (If Applicable) Female 16. Home Telephone Number Business Phone Number Business Fax Number Fax Number 17. Marital Status Married Mobile/Cell Number Pager Number 18. Spouse's Full Name (Even if divorced or separated, include maiden name.) 19. Spouse's DOB (dd-mmm-yyyy) Single (Never Married) Separated Widowed Divorced 20. Name and Address of Present Employer or School Name Address 21. Present Occupation (If retired, write "retired". If student, write "student".) 22. When do you intend to arrive in the U.S.? (Provide specific date if known) (dd-mmm-yyyy) 23. E-Mail Address 24. At what address will you stay in the U.S.? BARCODE 25. Name and telephone numbers of person in U.S. who you will be staying with or visiting for tourism or business: Name Home Phone Business Phone 26. How long do you intend to stay in the U.S.? DO NOT WRITE IN THIS SPACE Cell Phone 27. What is the purpose of your trip? 50 mm x 50 mm PHOTO staple or glue photo here 28. Who will pay for your trip? 29. Have you ever been in the U.S.? Yes No When? For how long? DS-156 06-2011 PREVIOUS EDITIONS OBSOLETE Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 30. Have you ever been issued a U.S. visa? Yes No 31. Have you ever been refused a U.S. visa? When? Where? Yes No Yes No When? Where? What type of visa? 32. Do you intend to work in the U.S.? Yes (If YES, give the name and complete address of U.S. employer.) No What type of visa? 33. Do you intend to study in the U.S.? (If YES, give the name and complete address of the school.) 34. Names and relationships of persons traveling with you 36. Has anyone ever filed an immigrant visa petition on your behalf? If Yes, who? Yes No Yes No 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.). Husband/ Fiance/ Yes No Yes No Yes No Wife Fiancee 35.Has your U.S. visa ever been cancelled or revoked? Father/ Son/ Brother/ Yes No Mother Daughter Sister 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 Yes No 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 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 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? Have you ever participated in, ordered, or engaged in genocide, torture, or extrajudicial killings? Have you ever engaged in the recruitment of or the use of child soldiers? 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. 39. Was this application prepared by another person on your behalf? (If answer is YES, then have that person complete item 40.) Yes No 40. Application Prepared By Name Relationship to Applicant Address Signature of Person Preparing Form Date (dd-mmm-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-mmm-yyyy) Privacy Act 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/GIS/DIR, Washington, DC 20520. DS-156 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com