San Francisco India - Visa Application Form Page 6
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10VISA QUESTIONNAIRE
INDIA
Do you hold any other valid passports?
No
Yes, details below:
Passport Number:_____________________________________________
Issuing Authority/Place of Issue:
US Department of State
Other:_____________________________
Date of Issue:_____ / _____________ / ________
Date of Expiry:_____ / _____________ / ________
Day
Month
Year
Day
Month
Year
YOUR CONTACT INFORMATION:
Home Address:____________________________________________________________________________________
City:__________________________________________
State:____________________
Zip Code:___________
This address must match the address on your Driver’s License and must be a street address - NO PO BOXES. If a PO Box
address is shown on your Driver’s License, you must submit a gas, water, or electric bill in your name with a street address.
Is this your permanent address?
Yes
No, permanent address listed below:
Permanent Address:________________________________________________________________________________
Non-US citizens must list their most recent address in their home country here.
City:_______________________
State:___________
Zip Code:___________
Country:_________________
Home Telephone:________________________________
Mobile Telephone:________________________________
Home Email:_______________________________________________________________________________________
YOUR FAMILY INFORMATION:
Your Father’s Full Name (even if deceased):_______________________________________________________________
Father’s Place of Birth: City:_______________________________________________ State:______________________
Father’s Country of Birth:
USA
Other:_____________________________________________________
Father’s Citizenship:
USA
Other:__________________
____________________
Previous Citizenship, if any:
Your Mother’s Full Name (even if deceased):_______________________________________________________________
Mother’s Place of Birth: City:_______________________________________________ State:______________________
Mother’s Country of Birth:
USA
Other:_____________________________________________________
Mother’s Citizenship:
USA
Other:__________________
____________________
Previous Citizenship, if any:
Your Marital Status:
Married
Unmarried (including single, divorced, or widowed)
If married, complete the following:
Your Spouse’s Full Name:_____________________________________________________________________________
Spouse’s Citizenship:
USA
Other:__________________
____________________
Previous Citizenship, if any:
Spouse’s Place of Birth: City:_______________________________________________ State:______________________
Spouse’s Country of Birth:
USA
Other:____________________________________________________
Were any of your grandparents citizens or residents of Pakistan?
No
Yes (provide details below)
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__________________________________________________________________________________________________
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