Form Ds-2003 (Formerly Dsp-110) - Notification Of Appointment Of Foreign Diplomatic Officer And Career Consular Officer

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OMB APPROVAL NO. 1405-0062
EXPIRATION DATE: 06-30-2006
ESTIMATED BURDEN: 25 MINUTES *
U.S. Department of State
FOR OFFICIAL USE ONLY
NOTIFICATION OF APPOINTMENT
P
R
OF FOREIGN DIPLOMATIC OFFICER
A
T
AND CAREER CONSULAR OFFICER
PID
Recognition Date (mm-dd-yyyy)
TO: Secretary of State, Attention - Office of Protocol
1. FROM (Name of Embassy/Mission)
2. TYPE OF OFFICER
DIPLOMATIC
CONSULAR
EMBASSY
MISSION TO INTERNATIONAL ORGANIZATION
WORLD BANK
INTERNATIONAL MONETARY FUND
CONTACT NAME AND TELEPHONE NO.
OTHER
3. FULL NAME
(a) SURNAME (Last)
(b) GIVEN (First)
(c) MIDDLE
(d) PREFIX OR RANK
(e) SUFFIX
(f) MAIDEN
(g) OTHER
MALE
FEMALE
Is the correct sequence for printing name a, b, c, e?
YES
NO.
If No, give correct sequence:
ABBREVIATED
NAME:
Please indicate how name should appear on documents (identification cards, etc.) Surname first.
4. CURRENT CITIZENSHIP
5. DATE OF BIRTH (mm-dd-yyyy)
6. CITIZENSHIP AT BIRTH
7. PLACE OF BIRTH (City, Country)
8. TYPE OF PASSPORT
9. TYPE OF VISA
A1
A2
OTHER
DIPLOMATIC
OFFICIAL
REGULAR
OTHER
(Specify type)
G1
G2
G3
G4
ATTACH COPIES OF ENTRY/DEPARTURE FORM I-94, AND TITLE AND VISA PAGES FROM PASSPORT. STAPLE TO FORM.
11. RESIDENCE ADDRESS
10. LAST ARRIVAL IN U.S.A. (mm-dd-yyyy)
TEMPORARY
PERMANENT
DATE:
NUMBER
STREET (AVE., BLVD, PLACE, ETC.)
APT.
PORT OF ENTRY
MANNER OF ENTRY
CITY
STATE
ZIP
TELEPHONE
12. EMPLOYING OFFICE
13. DUTY OFFICE (If different from employing office)
NAME OF OFFICE
NAME OF OFFICE
NUMBER
STREET (AVE., BLVD, PLACE, ETC.)
SUITE
NUMBER
STREET (AVE., BLVD, PLACE, ETC.)
SUITE
CITY
STATE
ZIP
CITY
STATE
ZIP
TELEPHONE
EXT.
TELEPHONE
EXT.
14. JOB TITLE
15. DATE OF ENTRY ON DUTY (mm-dd-yyyy)
Head of post?
YES
NO
17. NAME, TITLE AND PID (IF AVAILABLE) OF PREDECESSOR AND
16. EXPECTED DATE OF DEPARTURE (mm-yyyy)
DATE (mm-yyyy) OF TERMINATION
19. ARE ANY IMMEDIATE FAMILY MEMBERS EMPLOYED BY A
18. WILL OFFICER SERVE IN ANOTHER OFFICIAL CAPACITY?
FOREIGN GOVERNMENT IN THE UNITED STATES?
YES
NO
If YES, give position and duty office:
YES
NO
If YES, give names and duty office:
EACH PERSON MUST SUBMIT A SEPARATE NOTIFICATION OF
APPOINTMENT.
DS-2003
(Formerly DSP-110)
Page 1 of 4
06-2003

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