Personal, Address, Phone, and Passport/Travel Document Information

Name Provided:

Full Name in Native Language:

Other Names Used:

Telecode Name Used:

Sex:

Marital Status:

Date of Birth:

Place of Birth:

Country/Region of Origin (Nationality):

Do you hold or have you held any nationality other than the one
indicated above on nationality?

Are you a permanent resident of a country/region other than your

country/region of origin (nationality) above?

National Identification Number:

U.S. Social Security Number:

U.S. Taxpayer ID Number:

Home Address:

City:

State/Province:

Postal Zone/ZIP Code:

Country/Region:

Same Mailing Address?

Primary Phone Number:

Secondary Phone Number:

Work Phone Number:

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Do you have any additional phone numbers?

Additional Phone: (1):

Email Address:

Do you have any additional email addresses?

Do you have a social media presence?

Social Media Platform: (1):

Social Media Identifier:

Do you have any additional social media presence?

Social Media Platform: (1):

Social Media Identifier:

Passport/Travel Document Type:

Passport/Travel Document Number:

Passport Book Number:

Country/Authority that Issued Passport/Travel Document:

City Where Issued:

State/Province Where Issued:

Country/Region Where Issued:

Issuance Date:

Expiration Date:

Have you ever lost a passport or had one stolen?

Travel Information
The List of Purposes of Trip to the U.S.

Purpose of Trip to the U.S. (1):

Specify:

Have you made specific travel plans?

Intended Date of Arrival:

Intended Length of Stay in U.S.:

Address where you will stay in the U.S.:

City, State, Postal/Zip Code:

Person/Entity Paying for Your Trip:

Person Paying for Your Trip:

Telephone Number:

Email Address:

Relationship to You:

Is the address of the party paying for your trip the same as your Home
or Mailing Address?

Are there other persons traveling with you?

Are you traveling as part of a group or organization?

Persons Traveling with You:

Name (1):

Relationship to You:

Have you ever been in the U.S.?

Date Arrived (1):

Length of Stay:

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Do you or did you hold a U.S. Driver's License?

Have you ever been issued a U.S. Visa?

Date Last Visa was Issued:

Visa Number:

Are you applying for the same type of visa?

Are you applying in the same country where the visa above is issued
and is this country your principal country of residence?

Have you been ten-printed?

Has your U.S. Visa ever been lost or stolen?

Has your U.S. Visa ever been cancelled or revoked?

Have you ever been refused a U.S. Visa, or been refused admission to
the United States, or withdrawn your application for admission at the
port of entry?

Explain:

Has anyone ever filed an immigrant petition on your behalf with the
United States Citizenship and Immigration Services?

U.S. Contact Information

Contact Person Name in the U.S.:

Organization Name in the U.S.:

Relationship to You:

U.S. Contact Address:

Phone Number:

Email Address:

Family Information
Father's Surnames:

Father's Given Names:

Father's Date of Birth:

Is your father in the U.S.?

Mother's Surnames:

Mother's Given Names:

Mother's Date of Birth:

Is your mother in the U.S.?

Do you have any immediate relatives, not including parents in the U.S.? NO

Do you have any other relatives in the United States?

Spouse's Full Name:

Spouse's Date of Birth:

Spouse's Country/Region of Origin (Nationality):

Spouse's City of Birth:

Spouse's Country/Region of Birth:

Spouse’s Address:

Work/Education/Training Information
Primary Occupation:

Specify Other:

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Present Employer or School Name:

Address:

City:

State/Province:

Postal Zone/Zip Code:

Country/Region:

Work Phone Number:

Monthly Salary in Local Currency (if employed):

Briefly Describe your Duties:

Were you previously employed?

Have you attended any educational institutions at a secondary level or

above?

Name of Institution (1):

Address of Institution:

City:

State/Province:

Postal Zone/ZIP Code:

Country/Region:

Course of Study:

Date of Attendance From:

Date of Attendance To:

Do you belong to a clan or tribe?

Provide a List of Languages You Speak:

Language Name (1):

Language Name (2):

Have you traveled to any countries/regions within the last five years?

Provide a List of Countries/Regions Visited

Country/Region (1):

Country/Region (2):

Country/Region (3):

Country/Region (4):

Country/Region (5):

Country/Region (6):

Have you belonged to, contributed to, or worked for any professional,
social, or charitable organization?

Do you have any specialized skills or training, such as firearms, NO

explosives, nuclear, biological, or chemical experience?

Have you ever served in the military? NO

Have you ever served in, been a member of, or been involved with a NO
paramilitary unit, vigilante unit, rebel group, guerrilla group, or
insurgent organization?

Security and Background Information

Do you have a communicable disease of public health significance? (Communicable diseases of public significance NO
include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious
stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human
Services.)

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Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of NO
yourself or others?

Are you or have you ever been a drug abuser or addict? NO

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or NO
other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? NO

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been NO
engaged in prostitution or procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money laundering? NO

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the NO
United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human NO
trafficking offense in the United States or outside the United States and have you within the last five years,
knowingly benefited from the trafficking activities?

Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or conspired to NO
commit a severe human trafficking offense in the United States or outside the United States?

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the NO
United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist NO
activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist NO
organizations?

Are you a member or representative of a terrorist organization? NO

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing NO
financial assistance or other support to terrorists or terrorist organizations, in the last five years?

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? NO

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? NO

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, NO
or other acts of violence?

Have you ever engaged in the recruitment or the use of the child soldiers? NO

Have you, while serving as a government official, been responsible for or directly carried out, at any time, NO
particularly severe violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a NO
woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or
her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue? NO

Have you ever been the subject of a removal or deportation hearing? NO

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United NO
States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you failed to attend a hearing on removability or inadmissibility within the last five years? NO

Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or NO
otherwise violated the terms of a U.S. visa?

Have you ever been removed or deported from any country? NO

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal NO
custody by a U.S. court?

Have you voted in the United States in violation of any law or regulation? NO

Have you ever renounced United States citizenship for the purpose of avoiding taxation? NO

Have you attended a public elementary school on student (F) status or a public secondary school after November NO
30, 1996 without reimbursing the school?

Location Information
Location where you will be submitting your application

Current Location: KARACHI, PAKISTAN

Preparer of Application

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Did anyone assist you in filling out this application? NO

You electronically signed your application on 14-Oct-2022 09:32:29 (GMT-05:00). You were required to electronically sign your
application yourself, unless otherwise exempt by regulation, even if the application was prepared by someone other than yourself.
Your electronic signature certifies that you have read and understood the questions in this application and that your answers are true
and correct to the best of your knowledge and belief. The submission of an application containing any false or misleading statements
may result in the permanent refusal of a visa or the denial of entry into the United States. All declarations made in this application
are unsworn declarations made under penalty of perjury. (28 U.S.C. 1746).

You certified that you understand that you are required to submit your visa to the United States Immigration Officer at the port
where you apply to enter the United States, and that possession of the visa does not entitle you to enter the United States if, upon
your arrival, you are found to be inadmissible under U.S. immigration laws. You certified that you understand that any willfully false
or misleading statement or willful concealment of a material fact made by you within the application may subject you to permanent
exclusion from the United States and, if you are admitted to the United States, may subject you to criminal prosecution and/or
deportation.

The information that you have provided in your application and other information submitted with your application may be accessible
to other government agencies having statutory or other lawful authority to use such information, including for law enforcement and
immigration law enforcement purposes. If fingerprints are collected as part of your application process, they may be used for the
purpose of comparing them to other fingerprints in the FBI’s Next Generation Identification (NGI) fingerprint system or its successor
systems (including civil, criminal, and latent fingerprint repositories). The photograph that you provide with your application may be
used for employment verification or other U.S. law purposes.

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