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Formulir Isian Usa

The document is a visa application form for the United States that collects personal information such as name, date of birth, passport information, contact details, family information, and employment details. It requests information like address, phone number, nationality, purpose and duration of trip, references in the US, occupation, and employer details. For male applicants under 45, it also asks for education history including names and addresses of primary school, high school, and university attended as well as years of attendance and field of study.

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Fika Febriana
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125 views

Formulir Isian Usa

The document is a visa application form for the United States that collects personal information such as name, date of birth, passport information, contact details, family information, and employment details. It requests information like address, phone number, nationality, purpose and duration of trip, references in the US, occupation, and employer details. For male applicants under 45, it also asks for education history including names and addresses of primary school, high school, and university attended as well as years of attendance and field of study.

Uploaded by

Fika Febriana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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FORMULIR VISA AMERIKA

( PERSONAL , ADDRESS, PHONE, AND PASSPORT INFORMATION )

1. Name Provided : ______________________________________

Full Name in Native Language : ___________________________________

Other Name Used : _______________________________________

2. Sex : _______________________________________

Marital Status : _______________________________________

Date Of Birth : _______________________________________

Place Of Birth : _______________________________________

Nationality : _______________________________________

Other Nationalities : ________________________________________

3. National Identification Number : ____________________________________

U.S Social Security Number : ____________________________________

U.S Taxpayer ID Number : ____________________________________

Home Address : ____________________________________

City : ____________________________________

State/ Province : _____________________________________

Postal Zone/ZIP Code : _____________________________________

Country : _____________________________________

Same Mailing Address ? : _____________________________________

Home Phone Number : ______________________________________

Work Phone Number : _______________________________________

Work Fax Number : _______________________________________


Mobile/Cell Phone Number : ________________________________

Email / Address : ________________________________

Passport Number : ________________________________

Passport Book Number : _________________________________

Country / Authority that Issued Passport : ___________________________

City Where Issued Passport : ____________________________

State / Province Where Issued : ____________________________

Country Where Issued : ____________________________

Issuance Date : _____________________________

Expiration Date : _____________________________

Have you ever lost a passport or had one stolen ? : ______________________

TRAVEL INFORMATION :

Principal Applicant : ______________________________

Purpose of Your Trip to U.S.

Intended Date of Arrival : ______________________________

Intended Length of Stay in U.S. : ______________________________

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

________________________________

Person/Entity Paying for Your Trip : _______________________________

Other Persons Traveling with you : _______________________________

Have you ever been in the U.S. ? : _______________________________

Have you ever been issued a U.S. visa ? : ____________________________


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

_________________________________

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 ths U.S. : __________________________________

Do you have any immediate relatives,


not including parents in ths U.S ? : __________________________________
Do you have any other relatives in the United States : ______________________

Spouse’s Full Name : ________________________________________

Spouse’s Date of Birth : ________________________________________

Spouse’s Nationality : ________________________________________

Spouse’s City of Birth : ________________________________________

Spouse’s Country of Birth : ________________________________________

Spouse’s Address : ________________________________________

WORK / EDUCATION / TRAINING INFORMATION :

Primary Occupation : _______________________________________

Present Employer or School Name : _________________________________

________________________________________

Address : _______________________________________

________________________________________

City : ________________________________________

State / Province : ________________________________________

Postal Zone / Zip Code : ________________________________________

Country : ________________________________________

Monthly Salary in Local Currency ( if employed ) : ________________________

Briefly Describe your Duties : ________________________________________


HARUS DIISI OLEH PE,OHON LAKI2 DIBAWAH USIA 45 TAHUN :

1. NAMA SEKOLAH MENEGAH PERTAMA…….


ALAMAT ……………..
DARI TAHUN .. SD …..

2.NAMA SEKOLAH MENENGAH ATAS ………………


ALAMAT ………………….
DARI TAHUN ……..S/D …………….
JURUSAN ………………….

3.NAMA UNIVERSITAS ……………………………


ALAMAT …………………………..
DARI TAHUN…S/D …………………..
JURUSAN …………………………

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