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U.S Department of State

NONIMMIGRANT VISA APPLICATION

Approved OMB 1405-0018
Expires 09/30/2007
Estimated Burden 1 hour
See 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
3. Issuing Country
 4. Issuance Date (dd-mmm-yyyy)
 5. Expiration Date (dd-mmm-yyyy)
 DO NOT WRITE IN THIS SPACE
B-1/B-2 MAX     B-1 MAX     B-2 MAX
Other __________________ MAX
Visa Classification
Mult or ________________
Number of Applications
Months ________________
Validity
Issued/Refused
On ____________ By ____________
Under SEC. 214(b)     221(g)
Other
INA
Reviewed By ________________
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-mmm-yyyy)
11. Place of Birth:
City Country State/Province 		12. Nationality
13. Sex
 14. National Identification Number
(If applicable)
 15. Home Address (Include apartment number, street, city state or province, postal zone and country)
16. Home Telephone Number
 Business Phone Number
 Mobile/Cell Number
Fax Number
 Business Fax Number
 Pager Number
17. Marital Status
 18. Spouse's Full Name (Even if divorced or separated. Include maiden name.)
20. Name and Address of Present Employer or School
Name: 		19. Spouse's DOB (dd-mmm-yyyy)
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)
23. E-Mail Address
 24. At What Address Will You Stay in The U.S.?
BARCODE
25. Name and Telephone Numbers of Person in U.S. Who You Will Be Staying With
or Visiting for Tourism or Business
Name
 Home Phone
Business Phone
 Cell Phone
26. How Long Do You Intend
To Stay in The U.S.?
 27. What is The Purpose of Your Trip?

50 mm x 50 mm

PHOTO

staple or glue photo here
28. Who Will Pay for Your Trip?
 29. Have You Ever Been in The U.S.?

WHEN?

FOR HOW LONG?

DS-156
09-2004

PREVIOUS EDITIONS OBSOLETE

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