U.s. Embassy, Rangoon - Supplemental Immigrant Visa Application printable pdf download

U.s. Embassy, Rangoon - Supplemental Immigrant Visa Application

U.S. Embassy, Rangoon

SUPPLEMENTAL IMMIGRANT VISA APPLICATION

PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM

PLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS

1. Last Name (s) (List all spellings)

2. First Name(s) (List all spellings)

3. Full Name (In Burmese)

4. Date of Birth (mm-dd-yyyy)

5. Place of Birth (City/Town , State/Division/Province , Country)

6. Permanent Home Address and Telephone Number (include apartment number, street, city, state/division or province, postal code, and country)

7. Full Name and Address of contact Person or Organization in the United States (include telephone number)

8. List All Countries You Have Entered in the Last Ten Years

9. List All Countries that Have Ever Issued You a

10. Have you ever lost a passport or had one stolen?

(Give the Year of Each Visit)

Passport

11. List all Professional, Social, and Charitable Organizations to Which You Belong

12. Do you have any specialized skills or training, including firearms, explosives, nuclear,

(Belonged) or Contribute (Contributed) or with Which You Work (Have Worked)

biological, or chemical experience? If YES, please explain.

13. Have you ever performed military service?

If YES, complete below.

Name of Country

Branch of Service

Rank/Position

Military Specialty

Dates of Service (mm-dd-yyyy) or “Present”

14. Have you ever been in an armed conflict, either as a participant or victim? If YES, please explain.

15. List all educational institutions you have attended. Include vocational institutions but not elementary schools.

Name of Institution

Address/Telephone

Course of Study

Dates of Attendance FROM – TO (mm-dd-yyyy) or “Present”

16. List at least TWO (2) Contacts in Burma Who Can Verify Information About Applicant (do not include immediate family members or other relatives)

Name

Address

Telephone Number

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U.s. Embassy, Rangoon - Supplemental Immigrant Visa Application