US Visa Assist

Personal 1

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

Surname (Last or Family Name) *

Given Name (First Name) *

Full name in your native alphabet

Does not apply / Technology not available

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

Yes

No

Do you have a telecode that represents your name? *

Yes

No

Telecode Surnames *

Telecode Given Names *

Gender *

Female

Male

Marital Status *

Other Marital Status *

Date and Place of Birth

City *

State/Province/Territory

Does not apply

Country of birth *

Personal 2

Country/Region of Origin (Nationality) *

Do you belong to a clan or tribe? *

Yes

No

Clan or Tribe Name *

Languages known *

Other languages you speak - Not listed above *

Yes

No

Enter Additional Languages * Press the Tab or Enter key after entering each language.

Do you now or have you ever held any nationality other than the one indicated above? *

Yes

No

Are you a permanent resident of a country/region other than your country/region of origin (nationality) indicated above? *

Yes

No

National Identification Number *

Does not apply

U.S. Social Security Number *

Does not apply

U.S. Taxpayer ID *

Does not apply

U.S. VISA Application

Personal

Personal 1

Date and Place of Birth

Personal 2