QUESTIONS FOR US VISA APPLICATION NOTE THAT SOME QUESTIONS MAY NOT APPLY TO YOU

You will need the following:

1. US$185 = $510EC for visa (US Embassy visa fee)

2. $156EC You will need to pay for premium delivery (DHL) to return your passport
2. $200EC application fee
3. 1 electronic passport photo for visa application (emailed to me richardshanemaxwell@gmail.com)
4. 1 hard copy passport photo for embassy
5. Job letter/school letter/business letter
6. Bank or credit union statement
7. Invitation letter from the person you are going to visit (make sure it is stamped by a lawyer,
solicitor, notary, JP)

8. Ensure that you have old passport with expired visa available if you are renewing & Passport valid for
at least 6 months

Due to limited flights to Barbados, you will need to spend 1 night in Barbados before your appointment
date and can return the same day after your appointment.

The following are the visa application questions some may not apply to you.
Name Provided: First Name/Middle Name/Surname

Full Name in Native Language: Other Names Used:

Telecode Name Used: N/A Sex:

Marital Status: Date of Birth: Place of Birth: Country/Region of Origin (Nationality):

Do you hold or have you held any nationality other than the one indicated above on nationality?

Are you a permanent resident of a country/region other than your country/region of origin (nationality)
above?

National Identification Number: U.S. Social Security Number: N/A

U.S. Taxpayer ID Number: N/A

Home Address: City: State/Province:

Postal Zone/ZIP Code: Country/Region:

Is your home address Same Mailing Address? If No what is your mailing address?

Mailing Address: City: State/Province:

Postal Zone/ZIP Code:

Country/Region: Primary Phone Number: Secondary Phone Number:

Work Phone Number: Do you have any additional phone numbers?

Email Address:
Do you have any additional email addresses?

Do you have a social media presence? FB/Instagram etc Social Media Platform: (1):

Social Media Identifier: Social Media Platform: (2):

Social Media Identifier:

Do you have any additional social media presence?

Passport/Travel Document Type: Passport/Travel Document Number:

Passport Book Number:

Country/Authority that Issued Passport/Travel Document: City Where Issued:

Country/Region Where Issued: Issuance Date:

Expiration Date: Have you ever lost a passport or had one stolen?

Travel Information

The List of Purposes of Trip to the U.S.

Purpose of Trip to the U.S. (1):

Specify:

Have you made specific travel plans? Intended Date of Arrival:

Intended Length of Stay in U.S.:

Address where you will stay in the U.S.:

City, State, Postal/Zip Code:

Person/Entity Paying for Your Trip:

Are there other persons traveling with you? Have you ever been in the U.S.?

Have you ever been issued a U.S. visa?

Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn
your application for admission at the port of entry?

If you were ever denied a visa, indicate the date and reason for denial?

Are you married? Yes/N0 Spouse Name and Nationality

Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and
Immigration Services?
U.S. Contact Information

Contact Person Name in the U.S.: Organization Name in the U.S.:

Relationship to You: U.S. Contact Address:

Phone Number: Email Address:

Family Information

Father's Surnames: Father's Given Names: Father's Date of Birth:

Is your father in the U.S.?

Mother's Surnames: Mother's Given Names: Mother's Date of Birth:

Is your mother in the U.S.?

Do you have any immediate relatives, not including parents in the U.S.?

Relative Name (1): Status: U.S. CITIZEN/Permanent Resident

Spouse's Full Name: Date of Birth:

Spouse's Country/Region of Origin (Nationality): Spouse's City of Birth:

Spouse's Country/Region of Birth: Spouse’s Address:

Street Address: State/Province:

Postal Zone/ZIP Code: Country/Region:

Work/Education/Training Information

Primary Occupation:

Present Employer or School Name:

Address:

City: State/Province: Postal Zone/Zip Code: Country/Region:

Work Phone Number: Monthly Salary in Local Currency (if employed):

Briefly Describe your Duties: Have you ever been 10 finger printed?

Were you previously employed?

Have you attended any educational institutions at a secondary level or above? IF yes
Name of Secondary School Date of Entry Date of Departure

Do you belong to a clan or tribe? Provide a List of Languages You Speak:

Language Name (1):

Have you traveled to any countries/regions within the last five years? If yes List the countries

Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?

Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or
chemical experience?

Have you ever served in the military?

Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit,
rebel group, guerrilla group, or insurgent organization?

Security and Background Information YES/NO

Do you have a communicable disease of public health significance? (Communicable diseases of public
significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma
venereum, infectious stage syphilis, active tuberculosis, and others diseases as determined by the
Department of Health and Human Services.)

Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare
of yourself or others?

Are you or have you ever been a drug abuser or addict?

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon,
amnesty, or other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have
you been engaged in prostitution or procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money laundering?

Have you ever committed or conspired to commit a human trafficking offense in the United States or
outside the United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a
human trafficking offense in the United States or outside the United States and have you within the last
five years, knowingly benefited from the trafficking activities?
Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or
conspired to commit a severe human trafficking offense in the United States or outside the United
States?

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity
while in the United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in
terrorist activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist
organizations?

Are you a member or representative of a terrorist organization?

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including
providing financial assistance or other support to terrorists or terrorist organizations, in the last five
years?

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings,
political killings, or other acts of violence?

Have you ever engaged in the recruitment or the use of the child soldiers?

Have you, while serving as a government official, been responsible for or directly carried out, at any
time, particularly severe violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls
forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo
sterilization against his or her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any
other United States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you ever been removed or deported from any country?

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?

Have you voted in the United States in violation of any law or regulation?

Have you ever renounced United States citizenship for the purpose of avoiding taxation?

Location Information

Location where you will be submitting your application Current Location: BRIDGETOWN, BARBADOS