K-Visa Application Checklist Page 3

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I have attached the original and one photocopy of all the documents listed which apply to my case. I fully
realize that no advance assurance can be given regarding when or whether a visa will actually be issued to me,
and I also understand that I should NOT resign from my place of employment, sell any property, or make any
final travel arrangements until the visa has actually been issued and is in my possession.
Date: ______________________________
Case Number: ___________________________________________________________________
Print Name: _____________________________________________________________________
Current address: _________________________________________________________________
________________________________________________________________________________
Email Address: ___________________________________________________________________
Date of Proposed Travel: ______________________________________________
Signature: _________________________________________________________
Applicants are advised NOT to make any non-refundable travel plans. Issuance of a
visa is not guaranteed.
A Consular Officer will evaluate your case and make a final determination.
FRN-IV-11
5/2016

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