Online Nonimmigrant Visa Application (DS-160) Application ID AA00EKLMPT

Personal Information 1


OMB CONTROL NUMBER: 1405-0182
FORM NUMBER: DS-160
EXPIRATION DATE: 10/31/2024
ESTIMATED BURDEN: 90 MIN


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

(e.g., FERNANDEZ GARCIA)


(e.g., JUAN MIGUEL)

Help: Surnames

Enter all surnames as listed in your passport. If only one name is listed in your passport, enter that Surname.

Help: Given Names

If your passport does not include a given name, please enter 'FNU' in Given Names.

Help: Other Names

Other names used include your maiden name, religious name, professional name, or any other names which you are known by or have been known by in the past.

Help: Telecode

Telecodes are 4 digit code numbers that represent characters in some non-Roman alphabet names.


Help: Sex

Please select MALE or FEMALE

Date and Place of Birth

(Format: DD-MMM-YYYY)

Help: Date of Birth

If day or month is unknown, enter as shown in passport.

Help: Country/Region

Select the name that is currently in use for the place where you were born.

Public reporting burden for this collection of information is estimated to average 90 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: PRA_BurdenComments@state.gov

Confidentiality Statement
The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. INA Section 222(f) provides that the records of the Department of State and of diplomatic and consular offices of the United States pertaining to the issuance and refusal of visas or permits to enter the United States shall be considered confidential and shall be used only for the formulation, amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of such records may be made available to a court provided the court certifies that the information contained in such records is needed in a case pending before the court.