DS-156 Non Immigrant Visa Form
  • If a question does not apply or the answer is "none", type "none" or "N/A"
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Please complete the following in detail:


Liebman-Mimbu Client Number 


» Information About You
 Family Name (As in Passport) 
 Given Name (As in Passport) 
 Middle Name 
 All other names used (including maiden) 
 Birthdate  Passport Number 
 Place of Birth: (include Country, City and State/Province
 
 Nationality     Male      Female  
 National Identification Number 
 Marital Status 
 Home Address (include apartment number, street, city, state or province, postal zone, and country)
 
 Home Telephone     E-Mail Address 


» Information About Your Employment or School
 Present Occupation (If retired, write "retired")  
 Name of current Employer or School 
 Employer or School Address 
 Employers Phone    Employers Fax 


» Information About Your Trip
 What is the purpose of your trip?  
 What Address Will You Stay At In The USA?
 
 When do you intent to arrive in the U.S.?  
 How long do you intent to stay in the U.S.?  
 Who will pay for your trip?  
 Names and Relationships of the persons traveling with you:
 
 Do You Intend To Work in the USA?  Yes      No  
 If YES, give name and complete address of U.S. employer
 
 Do You Intend To Study in the USA?  Yes      NO  
 If YES, give name and complete address of school
 


» General Information
 Have You Ever Been To The USA?     YES      NO  
  If YES
 When     For how long?  
 Have your ever been issued a U.S. Visa?    YES      NO  
 If YES
 When?  Where? 
 What type of visa?
 Have your ever been refused a U.S. Visa?    YES      NO  
 If YES
 When?  Where?
 What type of visa?
 Has your U.S. visa ever been cancelled or revoked?    YES      NO  
 If YES
 When?    Where?
 Has anyone ever filed an Immigrant Visa petition on your behalf?    YES      NO  
Are any of the following persons in the U.S., or do they have U.S. legal permanent redidence or U.S. citizenship?
Mark YES or NO and indicate that person's status in the U.S. (i.e., U.S. legal permanent resident, U.S. citizen, visiting, studying, working, etc.).
 Husband/Wife YES   NO   
 Father/Mother YES   NO   
 Fiance/Finacee YES   NO   
 Son/Daughter YES   NO   
 Brother/Sister YES   NO   


» Additional Information
 IMPORTANT: All applicants must read and check the appropriate box for each item

A YES answer doesn not automatically signify ineligigility for a visa.

 A visa may not be issued to persons who are within specific categories defined by the law as inadmissible to the United States (except when a waiver is obtained in advance). Area any of the following applicable to you?
Have you ever been arrested or convicted for any offense or crime, even though subject to a pardon, amnesty or other similar legal action? Have you ever unlawfully distributed or sold a controlled substance (drug), or been a prostitute or procurer for prostitutes? YES     NO  
Have you ever been refused admission to the U.S., or been the subjext of a deportation hearing, or sought to obtain or assist others to obtain a visa, entry into the U.S., or any other U.S. immigration benefit by fraud or willful misrepresentation or other unlawful means? Have you attended a U.S. public elementary school on studen(F) status or a public secondary school after November 30, 1996 without reimbursing the school? YES     NO  
Do you seek to enter the United States to engage in export control violations, subversion or terrorist activities, or any other unlawful prupose? Are you a member or representative of a terrorist organization as currently designated by the U.S. Secretary of State? Have you ever participated in persecutions directed by the Nazi government of Germany; or have you ever participated in genocide? YES     NO  
Have you ever violated the terms of a U.S. visa, or been unlawfully present in, or deported from the United States? YES     NO  
Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court, voted in the United States in violation of any law or regulation, or renounced U.S. citizenship for the purpose of avoiding taxation? YES     NO  
Have you ever been afflicted with a communicable disease of public health significance or a dangerous physical or mental disorder, or ever been a drug abuser or addict? YES     NO  


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