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U.S. Visa type E requirement form
U.S. Visa type E requirement form
Surname
Given Names
Full Name in Native Alphabet
Click if you have ever used other name
Click if you have ever used other name
Another full name
Click if you have a telecode
Click if you have a telecode
Telecode
Gender
Click if you are male
Click if you are female
Married
Click if you are Married.
Date of birth (DD/MM/YYYY)
Place of birth: Place where you were born (city (village/town), state/province and country)
Country of birth: Use the current country name.
Nationality
Click if you hold or have held a different nationality, and include it in the next form field
Click if you hold or have held a different nationality, and include it in the next form field
Other Nationality
Click if you hold a passport of the other nationality
Click if you hold a passport of the other nationality
Other Passport Number.
Click if you are a permanent resident of a country/region other than your country/region (nationality) indicated above and include its name in the next form field
Click if you are a permanent resident of a country/region other than your country/region (nationality) indicated above and include its name in the next form field
Residence Country/Region
National Identification Number
Click If you have the US Social Security Number (US SSN):
Click If you have the US Social Security Number (US SSN):
US SSN,
Click If you have the US Taxpayer ID #: If you were issued an ITIN number or any other US taxpayer ID
Click If you have the US Taxpayer ID #: If you were issued an ITIN number or any other US taxpayer ID
U.S. taxpayer ID number
Full home address,
Mailing Address
Click If your mailing address is the same as your home address
Click If your mailing address is the same as your home address
Full mailing address
Primary phone number
Secondary phone number
Work phone number
Email Address
Click if you have ever lost a passport or had one stolen
Click if you have ever lost a passport or had one stolen
Click if you have a social media presence
Click if you have a social media presence
Social Media Provider/Platform where you have presence
Username in that Social Media Provider
Click if you have a social media presence
Click if your Passport/Travel Document is regular
Click if your Passport/Travel Document is Official
Click if your Passport/Travel Document is Diplomatic
Click if your Passport/Travel type is other
Passport/Travel Document Type:
Passport Number.
Passport Book Number:
Country/Authority that issued passport
Passport/Travel Document number
Passport Book Number
Country/Authority that Issued Passport/Travel Document
City where the passport was issued
State/Province, If shown on passport, where was issued
Country/Region where the passport was issued
Date when the passport was issued (DD/MM/YYYY)
Expiration date of the passport (DD/MM/YYYY)
And include the Country/Authority that Issued Passport/Travel Document
If you clicked the previous box, include the Passport/Travel Document Number, if its possible
And include the Country/Authority that Issued Passport/Travel Document*
Click if you have made specific travel plans and provide the following data
Click if you have made specific travel plans and provide the following data
Date of Arrival in U.S. (DD/MM/YYYY)
Arrival Flight (if known)
Arrival City
Date of Departure from U.S. (DD/MM/YYYY)
Departure Flight (if known)
Departure City
Provide the locations you plan to visit in the U.S.
Address Where You Will Stay in the U.S:
Trip
Click if you pay for the trip
Click if your present employer pays for the trip
Click if your present employer in the US pays for the trip
Click if other person/company pays for the trip
If you clicked other person/company pays for the trip, Click if the address of the party paying for your trip is the same as your Home or Mailing Address. If the address is different, provide it
Other person. Surnames of Person Paying for Trip
Other person. Given Names of Person Paying for Trip
Other person. Telephone Number
Other person. Email Address
Other person. Relationship to You
Other company. Name of Company/Organization Paying for Trip
Other company. Telephone Number
Other company. Relationship to you
Other company. Address of Company/Organization Paying
Travel
Click if there are other people traveling with you
Click if you are traveling as part of a group or organization
Group name
Click If you are traveling with other people but it isn’t a group or organization
Click If you are traveling with other people but it isn’t a group or organization
Surnames of Person Traveling with You
Given Names of Person Traveling with You
Relationship with person
Click if you have ever been in the U.S
Click if you have ever been in the U.S
Date Arrived (DD/MM/YYYY)
Length of Stay
Click if you do or did ever hold a U.S. Driver’s License
Click if you do or did ever hold a U.S. Driver’s License
Driver’s License Number
State of Driver’s License
Click if you have ever been issued a U.S. Visa
Click if you have ever been issued a U.S. Visa
Date Last Visa Was Issued (DD/MM/YYYY)
Visa Number
Click if you are applying for the same type of visa
Click if you are applying for the same type of visa
Click if you are applying in the same country or location where the visa above was issued, and is this country or location your place of principal or residence
Click if you have been ten-printed
Click if your U.S. Visa have ever been lost or stolen
Enter the year when the visa was lost or stolen and provide an explanation.
Click if you have ever been issued a U.S. Visa
Click if your U.S. Visa has ever been cancelled or revoked
Click if you have ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the point of entry
If you clicked the previous question, provide the details of that incident
Click if you are or you have ever been a U.S. legal permanent resident
Click if you are or you have ever been a U.S. legal permanent resident
If you clicked the previous question, provide an explanation
Provide the name of a contact person or organization in the US
Relationship to you
Address and Phone Number of contact person or organization
email of the contact person or organization
Father’s Surnames
Father’s Given Names
Father’s Date of Birth
Click if your father is in the U.S.
Click if your father is in the U.S.
If you clicked the previous question, click if your father is a U.S. Citizen
If you clicked the previous question, click if your father is a U.S. legal permanent resident (LPR)
If you clicked the previous question, click if your father is a Nonimmigrant
If you clicked the previous question, click if your father is Other / i don’t know
Mother’s Surnames
Mother’s Given Names
Mother’s Date of Birth
Click if your mother is in the U.S.
Click if your mother is in the U.S.
If you clicked the previous question, click if your mother is a U.S. Citizen
If you clicked the previous question, click if your mother is a U.S. legal permanent resident (LPR)
If you clicked the previous question, click if your mother is a Nonimmigrant
If you clicked the previous question, click if your mother is Other / i don’t know
Click if you have any immediate relatives, not including parents, in the United States
If you clicked the previous question, provide immediate relative surnames
If you clicked the previous question, provide immediate relative Given Names
If you clicked the previous question, provide immediate relative relationship to you
If you clicked the previous question, click if your immediate relative is a U.S. Citizen
If you clicked the previous question, click if your immediate relative is a U.S. Citizen
If you clicked the previous question, click if your immediate relative is a U.S. legal permanent resident (LPR)
If you clicked the previous question, click if your immediate relative is a Nonimmigrant
If you clicked the previous question, click if your immediate relative is Other / i don’t know
Spouse’s Surnames
Spouse’s Given Names
Spouse’s Date of Birth (DD/MM/YYYY)
Spouse’s Country/Region of Origin (Nationality)
Spouse’s Place of Birth
Click if your spouse’s address is the same as home address
Click if your spouse’s address is the same as home address
Click if your spouse’s address is the same as mailing address
Click if your spouse’s address is the same as U.S. contact address
Click if you do not know your spouse’s address
If your spouse’s address is “other” provide your spouse’s complete address
Click if your Primary Occupation is Agriculture
Click if your Primary Occupation is Agriculture
Click if your Primary Occupation is Artist/Performer
Click if your Primary Occupation is Business
Click if your Primary Occupation is Communications
Click if your Primary Occupation is Computer Science
Click if your Primary Occupation is Culinary/Food Services
Click if your Primary Occupation is Education
Click if your Primary Occupation is Engineering
Click if your Primary Occupation is Government
Click if your Primary Occupation is Homemaker
Click if your Primary Occupation is Legal Profession
Click if your Primary Occupation is Medical/Health
Click if your Primary Occupation is Military
Click if your Primary Occupation is Natural Science
Click if you are Not Employed
Click if your Primary Occupation is Physical Sciences
Click if your Primary Occupation is Religious Vocation
Click if your Primary Occupation is Research
Click if you are Retired
Click if your Primary Occupation is Social Science
Click if your Primary Occupation is Student
Click if your Primary Occupation is Other
Provide an explanation if you clicked Other
Present Employer or School Name
Present Employer or School Address
Monthly Income in Local Currency (If employed)
Provide a brief description of your duties
Click if you belong to a clan or tribe
Click if you belong to a clan or tribe
Click if you belong to a clan or tribe
If you clicked the previous question, provide the Clan or Tribe Name
Provide a list of languages that you speak
If you traveled to any countries/regions within the last five years, provide a list of them
If you belonged to, contributed to, or worked for any professional, social, or charitable organization, provide a list of them
Click if you have ever been a member of the Taliban
Click if you have ever been a member of the Taliban
Click if you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience
If you clicked the previous question, provide an explanation in detail
Click if you have ever served in the military
Click if you have ever served in the military
Provide the Name of Country/Region where you performed military service
Provide the Branch of Service
Provide the Rank/Position
Provide the Military Specialty
Provide the Date of Service from (DD/MM/YYYY) to (DD/MM/YYYY)
Click if you have ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization
Click if you have ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization
If you clicked the previous question, provide an explanation in detail
Click if you were previously employed. If you click, provide the following information
Click if you have ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization
Employer Name
Employer’s Complete Address
Employer’s Telephone Number
Job Title
Supervisor’s Surname
Supervisor’s Given Names
Employment date from (DD/MM/YYYY)
Employment date to (DD/MM/YYYY)
Briefly describe your duties
Name of Institution
Click if you have attended any educational institutions other than elementary schools. If you click, provide the following information
Click if you have attended any educational institutions other than elementary schools. If you click, provide the following information
Institution’s Complete Address
Course of Study
Date of Attendance: from (DD/MM/YYYY) to (DD/MM/YYYY)
Click if you have a communicable disease of public health significance. Communicable diseases of public significance
Click if you have a communicable disease of public health significance. Communicable diseases of public significance
Click if you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others
Click if you are or you have ever been a drug abuser or addict.
Click if you have ever been arrested or convicted for any offense or crime, even though you are subject to a pardon, amnesty, or other similar action.
Click if you have ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances
Click if you are coming to the United States to engage in prostitution or unlawful commercialized vice, or you have been engaged in prostitution or procuring prostitutes within the past 10 years
Click if you have ever been involved in, or do you seek to engage in, money laundering
Click if you have ever committed or conspired to commit a human trafficking offense in the United States or outside the United States
Click if you have ever knowingly aided, abetted, assisted, or colluded with an individual who has committed or conspired to commit a severe human trafficking offense in the US or outside
Click if you are the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the US or outside
Click if you are the spouse, son, or daughter of an individual who has been identified by the President of the US as person who plays a significant role in a severe form of trafficking in persons
Click if you are the spouse, son, or daughter of an individual who has violated any controlled substance trafficking law, and have knowingly benefited from these activities in the past five years
Click if you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States
Click if you seek to engage in terrorist activities while in the United States, or you have ever engaged in terrorist activities
Click if you have ever, or you intend, to provide financial assistance or other support to terrorists or terrorist organizations
Click if you are a member or representative of a terrorist organization
Click if you have ever ordered, incited, committed, assisted, or otherwise participated in genocide
Click if you have ever committed, ordered, incited, assisted, or otherwise participated in torture
Click if you have committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence
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