USA VISA QUESTIONER
Appl. No:- AA00__________________ Interview Dt:-___________at ________ Language:-___________
A APPLICANT DETAILS AS PER PASSPORT
1 Full Name :- SANGANI SANJAYKUMAR PANCHABHAI
2 Holding previous / lost passport (If Any) :- YES / NO
3 Present Residence Address:- (If Different from passport)
Pin Code:-
4 Marital Status :- Married
5 Contact No:- (M) 93282 76224 (W) 99799 37376 (R)
6 Email:- accutec2890@gmail.com
B Details of principal applicant
FATHER Birth Date: 17/01/1950 Birth Place: Bhader, Rajkot, Is in USA:- NO
MOTHER Birth Date: 03/07/1959 Birth Place: Ishvariya, Rajkot, Is in USA:- NO
SPOUSE Birth Date: 01/02/1983 Birth Place : Bhola, Rajkot, Is in USA:- NO
C For Spouse of principal applicant
FATHER Birth Date Birth Place Is in USA:- YES / NO
MOTHER Birth Date Birth Place Is in USA:- YES / NO
SPOUSE Birth Date Birth Place Is in USA:- YES / NO
D Travel Plan and Duration of Stay
7 Purpose of Travel :- Visa Category:-
8 Travel Date:- Proposed Stay Period:-
11 How many accompany travelers :- ________________________
E List the name of social media applications you have been using in last 5 years.
YouTube :- ___________, Twitter:-___________, Face book:- sanjay.sangani.9,
Google+:-______________, LinkedIn/ Instagram:-_______________,
F Details of last issued USA visa ( Visa Copy required)
12 Visa No:- J4756358 Visa Issue Date:- 01 July 2014
13 Visa Issue Place:- Mumbai (Bombay) Visa Category:- B1/B2 , Purpose of Travel
G How many times your previous Visa had been Refused / Never applied before
1st time
2nd time
3rd time
4th time
Details:-
G Last five USA TRAVEL HISTORY (Passport Required)
14 (1) USA Arrival Dt:- 16/05/2024 INDIA Arrival Dt:- 08/06/2024 Total Stay: 23 Days
(2) USA Arrival Dt:- 31/05/2019 INDIA Arrival Dt: 08/06/2019 Total Stay: 9 Days
(3) USA Arrival Dt:- 17/08/2014 INDIA Arrival Dt:- 29/08/2014 Total Stay: 11 Days
(4) USA Arrival Dt:- ________ INDIA Arrival Dt:- _________ Total Stay: _____ Days
(5) USA Arrival Dt:- ________ INDIA Arrival Dt: _________ Total Stay: _____ Days
H Details of Green Card OR Immigration Petition filed (If Any)
15 Your Valid / Expired Green card No :-______________, Social Security No.________________
Your last arrival date in India on your Green Card :-___________
16 Category of Immigration Petition______ & Year ______ of filing.
Name of petitioner:- ______________________________ Relation with you :-________________
17 Immigration File No:-BMB//EAC//WAC :- _________________
18 Name of Friend / Any Relatives in the USA who are sponsoring You ( If Yes)
Name :-___________________________Relation:_______________ Visa Status______________
J Details of Blood Relatives in the USA
Have any blood relatives presently living in the USA :-Yes/NO (Siblings/Child/Parents)
19
Name ____________________________________ Relation :-____________________Visa status_______
Name ____________________________________ Relation :-____________________Visa status_______
Name ____________________________________ Relation :-____________________Visa status_______
K Details of contact person / sponsor in the USA
20 Name : Chandreshkumar Parsana
21 Relationship to you : Friend
22 Work Organization Name & Address :-
Postal code:________
23 Position/Designation:-
24 Residence Full address: 2138 Edward Stec Blvd, Edison, NJ
Postal code: 08837
25 Phone number : (M) 908 494 0726 (R)
26 Email address:- chandreshparsana43@gmail.com
L
Family Income Details (As per Last ITR)
27
Personal Rs. 20,05,040 + Other Rs.________
Spouse Rs. 5,18,240 + Other Rs.________
HUF Rs. 4,79,160 + Other Rs.________
M Details of Present Occupation Start Date:- 01/08/2017
28 Business
29 Name of firm/Company 1:- Universal Tools Industries
Name of firm/Company 2 (If Any):-
30 Position / Designation :- Partner
31 Work Address :- Plot No. 430, Road No.11, Kathwada GIDC, Phase-2, Kathwada, Ahmedabad-382430
32 Contact No: - (M) 93282 76224 (W) 99799 37376
33 Email address : unitool99@yahoo.com
34 Business Details :-
I AM A PARTNER CARRY ON THE ABOVE FAMILY FIRM WHICH IS ONE OF THE BIGGEST WOOD
WORKING TOOLS MANUFACTURING COMPANY IN INDIA. I LOOK AFTER BUSINESS DEVELOPMENT
OF THE COMPANY. I AM RESPONSIBLE FOR MARKETING STRATEGY FOR EXPANSION OF THE
BUSINESS BY INTRODUCING QUALITY & INNOVATIVE PRODUCTS IN THE MARKET TO OUR
SATISFIED CUSTOMER ACROSS INDIA. I REGULARLY DEAL WITH THE FOREIGN CLIENTS FOR
EXPORT OF OUR QUALITY PRODUCTS AND NEGOTIATION FOR IMPORT OF THE NEW TECHNOLOGY
MACHINERIES & TOOLS FORM EUROPEAN COUNTRIES,
N Previous profession Details of last 5 Yrs Retirement Date :-
36 Private Job - Business retired - Self employed – Professional – Government Retired
37 Name of firm/Company :-
38 Status / Designation :- __________
39 Full name of head of the company:- __________
40 Tenure of work From : dt__________ to :dt __________
41 Work Address :-
42 Contact no: (M) : __________ (O) : __________
43 Details:-
P EDUCATIONAL DETAILS – 1 (School or Graduation)
44 Name of School / College/ University :- H K Vora High School
45 Address :- Moti Marad, Rajkot
46 Course of Study :- Academic / Graduate in Higher Secondary
47 Passing year :- From July 1997 To:- April 1998
EUCATIONAL DETAILS – 2 (Post Graduate)
48 Name of School / College/ University :-
49 Address:-
50 Course of Study :- ____________ Passing year :- From _________ To _________
R Visited Countries in Last five Years:-
o Singapore o o Italy USA
o Malaysia o o
o Thailand o o
o o o Hungary Spain
o o Germany o
o o o
o China o o Nepal
o o o
o o o
DECLARATION OF APPLICANT
I undersigned have given my above personal information & details to my agent “Flamingo Transworld
Pvt Ltd” for the USA visa application process are true & correct to the best of my knowledge and valid to
the available papers which I can produce to visa officer during interview. I also declare that I personally
know my above mentioned sponsor who is my friend/Family relative, currently living in the USA on
legal/official visa status. I am responsible to check all the details/information filled up into my visa
application form before final submission by my travel agent to whom I have appointed for the
assistantship to process my visa application of which they are not giving any guarantee for approval of
the visa by any USA Consulate offices,
Signature _________________________________________ Date:- 12/06/2024
