美国签证申请156表.docVIP

DO NOT PRINT THIS PAGE. You must click the Continue button below and then print the form to complete the process. Please do not click the Continue button more than once. Your answers must be in English and must use English characters. 窗体顶端 U.S. Department of StateNONIMMIGRANT VISA APPLICATION Approved OMB 1405-0018Expires 09/30/2007Estimated Burden 1 hourSee Page 2 PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM 1. Passport Number 2. Place of Issuance: City Country State/Province DO NOT WRITE IN THIS SPACE 3. Issuing Country 4. Issuance Date (dd-month-yyyy) day month year 5. Expiration Date (dd-month-yyyy) day month year 6. Surnames (As in Passport) 7. First and Middle Names (As in Passport) 8. Other Surnames Used (Maiden, Religious, Professional, Aliases) 9. Other First and Middle Names Used 10. Date of Birth (dd-month-yyyy) day month year 11. Place of Birth City Country State/Province 12. Nationality 13. Sex Male Female 14. National Identification Number (If applicable) 15. Home Address (Include apartment number, street, city, state or province, postal zone and country)Street Address Line 1Street Address Line 2CityState/ProvincePostal CodeCountry 16. Home Telephone Number Business Phone Number Mobile/Cell Number Fax Number Business Fax Number Pager Number 17. Marital StatusMarried Single (Never Married)Widowed Divorced Separated 18. Spouses Full Name(Even if divorced or separated. Include maiden name.) 19. Spouses DOB (dd-month-yyyy) day month year 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) day month year 23. E-Mail Address 24. At What Address Will You Stay in The U.S.?Street Address Line 1Street Address Line 2CityState/ProvincePostal Code Barcode 25. Name and Telephone Numbers of Person in U.S. Who You Will B