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Nonimmigrant Visa Application

Personal Information 1


OMB CONTROL NUMBER: 1405-0182
FORM NUMBER: DS-160
EXPIRATION DATE: 07/31/2011
ESTIMATED BURDEN: 75 MIN


NOTE: Data on this page must match the information as it is written in your passport.

(e.g., FERNANDEZ GARCIA)


(e.g., JUAN MIGUEL)

Help: Surnames

Enter all surnames as listed in your passport. If only one name is listed in your passport, enter that Surname.

Help: Given Names

If your passport does not include a given name, please enter 'FNU' in Given Names.

Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)?

Help: Other Names

Other names used include your maiden name, religious name, professional name, or any other names which are known by or have been known by in the past.


Date and Place of Birth

(Format: DD-MMM-YYYY)

City of Birth

Help: Date of Birth

If day or month is unknown, enter as shown in passport.

Help: Country of Birth

The name of the country should be the name that is currently in use for the place where you were born.

Public reporting burden for this collection of information is estimated to average 75 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: A/ISS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202