Form Ds-157, 2010, Supplemental Nonimmigrant Visa Application

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U.S. Department of State

Approved OMB 1405-0134

Expires 03/31/2018

SUPPLEMENTAL NONIMMIGRANT VISA APPLICATION

Estimated Burden 1 Hour*

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 native alphabet)

4. Clan or Tribe Name (If applicable)

5. Spouse's Full Name (If married)

6. Father's Full Name

7. Mother's Full Name

8. Full Name and Address of Contact Person or Organization in the United States (Include telephone number)

11. Have you ever lost a passport

9. List all countries you have entered in the last ten years.

10. List all countries that have ever issued you a passport.

or had one stolen?

(Give the year of each visit)

Yes

12. Not including current employer, list your last two employers.

Dates of Employment

Name

Address

Telephone Number

Job Title

Supervisor's Name

(mm-dd-yyyy) or "Present"

From

13. List all professional, social and charitable organizations to which you belong

14. Do you have any specialized skills or training, including firearms,

(belonged) or contribute (contributed) or with which you work (have worked).

explosives, nuclear, biological, or chemical experience?

If YES, please explain.

Yes

15. Have you ever performed military service?

If yes, complete below.

Yes

Dates of Service

Name of Country

Branch of Service

Rank/Position

Military Specialty

(mm-dd-yyyy) or "Present"

From

16. Have you ever been in an armed conflict, either as a participant or victim?

If YES, please explain.

Yes

17. List all educational institutions you attend or have attended. Include vocational institutions but not elementary schools.

Dates of Attendance

Name of Institution

Address

Telephone Number

Course of Study

(mm-dd-yyyy) or "Present"

From

18. Have you made specific travel arrangements?

Yes

If YES, please provide a complete itinerary for your travel, including arrival/departure dates, flight information, specific location you will visit, and a point of contact

at each location.

CONFIDENTIALITY AND PAPERWORK REDUCTION ACT STATEMENTS

Confidentiality Statement -

INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation, amendment, administration, or

enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be made available to a court which certifies that the information contained in such records is

needed in a case pending before the court.

Paperwork Reduction Act Statement -

Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources,

gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently

valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: PRA_BurdenComments@state.gov

DS-157

03-2015