Form Ds-230 - Application For Immigrant Visa And Alien Registration
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4U.S. Department of State
OMB APPROVAL NO. 1405-0015
EXPIRES: 07/31/2018
APPLICATION FOR
ESTIMATED BURDEN: 1 HOUR*
(See Page 2)
IMMIGRANT VISA AND
ALIEN REGISTRATION
PART I - BIOGRAPHIC DATA
Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please
print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If there is insufficient room on the form, answer on a
separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.
Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States.
This form (DS-230 Part I) is the first of two parts. This part, together with Form DS-230 Part II, constitutes the complete Application for
Immigrant Visa and Alien Registration.
1. Family Name
First Name
Middle Name
2. Other Names Used or Aliases (If married woman, give maiden name)
3. Full Name in Native Alphabet (If Roman letters not used)
4. Date of Birth (mm-dd-yyyy)
5. Age
6. Place of Birth (City or Town)
(Province)
(Country)
7. Nationality (If dual national,
8. Gender
9. Marital Status
give both.)
Female
Single (Never Married)
Married
Widowed
Divorced
Separated
Male
Including my present marriage, I have been married
times.
10. Permanent address in the United States where you intend to live, if
11. Address in the United States where you want your Permanent
known (street address including ZIP code). Include the name of a person
Resident Card (Green Card) mailed, if different from address in item #10
who currently lives there.
(include the name of a person who currently lives there).
Telephone number
Telephone number
13. Present Address (Street Address) (City or Town) (Province) (Country)
12. Present Occupation
Telephone Number (Home)
Telephone Number (Office)
E-mail Address
14. Spouse's Maiden or Family Name
First Name
Middle Name
15. Date (mm-dd-yyyy) and Place of Birth of Spouse
17. Spouse's Occupation
16. Address of Spouse (If different from your own)
18. Date of Marriage (mm-dd-yyyy)
19. Father's Family Name
First Name
Middle Name
20. Father's Date of Birth
21. Place of Birth
22. Current Address
23. If Deceased, Give
(mm-dd-yyyy)
Year of Death
24. Mother's Family Name at Birth
First Name
Middle Name
25. Mother's Date of Birth
26. Place of Birth
27. Current Address
28. If Deceased, Give
(mm-dd-yyyy)
Year of Death
This Form May be Obtained Free at Consular Offices of the United States of America
Page 1 of 4
DS-230 Part I
Previous Editions Obsolete
07-2015
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