Visa Application DS 160 Form
Personal Information 1
Surname: ________________Given Name: _______________________
Full name in native Language :________________________________________(ภาษาไทย)
Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)?
ShapeShape
No. Yes. If yes, Provide the following information:
Other Surnames Used (maiden, religious, professional, aliases, etc.)___________________________
Other Given Names used________________________________
ShapeShapeOther Given Names used________________________________(ถ้าเปลี่ยนมากกว่า 1 ครั้ง)
Sex: Male Female
Marital Status: _______________________
Personal Information 2
Nationality: ______________________
ShapeShape Do you hold or have you held a nationality other than the one you have indicated above? No. Yes. If yes, ____________________________
National Identification Number: _________________________
U.S. Social Security Number: ____________________
Taxpayer ID Number: ________________________
Address and Phone Information
Home Address: ที่อยู่ตามทะเบียนบ้าน
Street Address: ___________________________City__________________
State/Province: _______________________Zip Code: ____________Country: __________
Phone
Home Phone Number: _________________ Mobile/Cell Phone Number: _____________
Fax no.____________________
Email Address: ___________________________________
Passport Information
Passport Number: ____________________
Country/Authority that Issued Passport: ________________________
Where was the Passport Issued? City: _____________________________
Country Where Issued: _______________________________
Issuance Date: Date ___________Month ____________Year___________
Expiration Date: Date ___________Month ____________Year___________
Passport Book No._________________
เลข 13 หลักหลังพาสปอร์ต
ShapeShapeHave you ever lost a passport or had one stolen?
Shape No. Yes. If yes,
Passport No._______________Do not know
Country/Authority that Issued Passport: _____________________
Travel Information
Intended Date of Arrival: __________________
Intended Length of Stay in U.S.: _____________________
Address Where You Will Stay in the U.S.
Street Address (Line 1): ______________________ Street Address (Line 2): ___________________
City: _________________State: _________________Zip Code: __________________
Sponsor Information
Surnames: __________________________ Given Name: ____________________________
Telephone Number: _______________ Email Address: ______________________________
Relationship to You: _________________
ShapeShapeIs the address of the party paying for your trip the same as your Home or Mailing Address?
Yes. No. If no, Provide the following information
Street Address: ___________________________City__________________
State/Province: ______________Zip Code: ____________Country: ___________________
Previous U.S. Travel Information
NOTE: Provide the following previous U.S. travel information. Provide complete and accurate information to all questions that require an explanation.
Have you ever been in the U.S.?
ShapeYes. No. If yes,
Provide information on your last five U.S. visits:
Date of Arrival: ________________________
Length of Stay: __________________________
ShapeHave you ever been issued a U.S. Visa?
Yes. No. If yes,
Previous U.S. Visas
Date Last Visa Was Issued: _________________________
ShapeShapeShapeVisa Number: _________________________ Do not know
Are you applying for the same type of visa? Yes. No.
ShapeShapeAre you applying in the same country where the visa above was issued and is this country your principal country of residence? Yes. No.
ShapeShapeHave you been ten-printed? Yes. No.
ShapeShapeShapeShapeHas your U.S. Visa ever been lost or stolen? Yes. No.
Has your U.S. Visa ever been cancelled or revoked? Yes. No.
ShapeShapeHave 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? Yes. No.
If Yes. Visa type: _________________ Year : __________________
Family Information: Relatives
Father's Full Name and Date of Birth
Surname: _________________________ Given name: _____________________________
ShapeShapeDate of Birth: _____________________
Is your father in the USA: Yes. No. If Yes, Father’s State: _____________
Mother's Full Name and Date of Birth
Surname: _________________________ Given name: _____________________________
ShapeShapeDate of Birth: _____________________
Is your mother in the USA: Yes. No. If Yes, Mother’s State: _____________
ShapeShape
Do you have any immediate relatives, not including parents, in the United States? Yes. No.
If yes, Provide the following information:
Surname: ____________________Given name: __________________________
Relationship to You: _______________ Relative’s Status: ______________
Previous Work/Education/Training Information
NOTE: Provide your employment information for the last five years, if applicable. ShapeShape
Were you previously employed? Yes No. (กรณีผู้ขอวีซ่าเคยเข้าร่วมโครงการ WT มาก่อน จะถือว่ามีประสบการณ์ในการทางาน ดังนั้นต้องใส่ข้อมูลและรายละเอียดเข้ามาด้วย) If yes. Provide the following information.
Employer/Employment Information:
Employer Name: __________________
Employer Address: ____________________________City: __________________________
State/Province: _______________________ Country: __________________________
Tel No. __________________
Job Title: _________________
Supervisor’s Surname: __________________ Supervisor’s Given name: ________________
Employment date from: _________________ To __________________
Briefly describe your duties: ___________________________________________________
__________________________________________________________________________
Present Education/Employment
Primary occupation: ________________________________
Present of employer/ School name: _________________________________________
Present of employer/ School address: __________________________City_______________
State/Province: ____________________ Country: _____________________
Briefly describe your duties: ___________________________________________________
Additional Work/Education/Training Information
NOTE: Provide the following work, education, or training related information. Provide complete and accurate information to all questions that require an explanation.
ShapeShape
Do you belong to a clan or tribe? Yes.No. If yes. Provide the following Information
Clan or Tribe Name: _______________________________________
ShapeShapeHave you traveled to any countries within the last five years? Yes.No. If yes. Provide a list of Countries visited
___________________________________
___________________________________
___________________________________
ShapeShapeHave you belonged to, contributed to, or worked for any professional, social, or charitable organization? Yes No.
ShapeShapeDo you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical Yes. No. If yes, please explain: ______________________
ShapeShapeHave you ever served in the military? Yes. No.
Security and Background: Medical and Health Information
NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.
Do you have a communicable disease of public health significance such as tuberculosis (TB)?
ShapeShape Yes. No. If yes, Explain ______________________________________________
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of your-self or others?
ShapeShape Yes. No. If yes, Explain ______________________________________________
ShapeShapeAre you or have you ever been a drug abuser or addict?
Yes. No. If yes, Explain ______________________________________________
Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?
ShapeShape Yes. No. If yes, Explain ______________________________________________
Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?
ShapeShape Yes. No. If yes, Explain ______________________________________________
Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?
Shape Yes. No. If yes, Explain ______________________________________________
Are you a member or representative of a terrorist organization?
Yes. No. If yes, Explain ______________________________________________
Have you ever ordered, incited, committed,