PROMPT SHEET FOR COMPLETING DS-160 Kindly read the !

r" and then ill #ith neatly$ PERSON%L INFORM%TION 1 Surname (Enter your surname as per your passport) Given names (Enter first & middle names as per passport) Have you ever used other names (Complete if applicable OR choose ' O') Se! (Choose "ale OR #emale) "arital Status (Choose one from drop do$n list) %ate of &irth (Enter %O& as per passport) 'lace of &irth (Enter as per passport) State('rovince of &irth (Clic) %oes ot *pply button)

Country of &irth (Choose Country from drop do$n list) PERSON%L INFORM%TION & ationality (Choose from drop do$n list) %o you hold other ationality (Choose +ES or O as applicable) ational ,dentification umber (Clic) %oes ot *pply' button) -S Social Security umber (Clic) %oes ot *pply' button) -S .a!payer ,% umber (Clic) %oes ot *pply' button) Cli'( Ne)t* %ddre++ and Ph!ne Home *ddress ('lease Enter) State('rovince 'ostal /onal /ip Code Country0 "ailin1 *ddress0 'rimary 'hone umber2 umber2

Secondary 'hone 3or) 'hone

umber2

Email address0 ( "andatory ) Cli'( Ne)t* Pa++,!rt 'assport umber0 Country(*uthority that issued 'assport ('lease Enter e0 10 ,reland) 3here $as 'assport issued State('rovince Country ,ssuance %ate of passport0

E!piration %ate of passport0 Have you ever lost(stolen 4ost 'assport o

Cli'( Ne)t* Tra-el 'urpose of .rip to -S*0 ,ntended len1th of stay in -S0 Have you made specific travel plans5 %ate of *rrival in -0S0 *rrival #li1ht2 *rrival City2 %ate of %eparture from -0S02 %eparture #li1ht %eparture City2 .he 4ocation(s) you plan to visit in the -0S *ddress $here you $ill stay in -S (,f you don't have an address please enter address (your -S Sponsor) belo$ or any intended hotel address $ith pincode and telephone no0 Street *ddress 4ine 6 (788 #ore Street) Street *ddress 4ine 9 City ('ortland) State ("aine) /ip Code (8:686) Per+!n.Entity ,ayin/ !r y!0r tri,$ Cli'( Ne)t* Tra-el C!",ani!n+ *re there other persons travelin1 $ith you5 ,f not travelin1 $ith family members; choose O Enter person(s) travelin1 $ith you Surnames of 'erson .ravelin1 3ith +ou; Given ames of 'erson .ravelin1 3ith +ou; Relationship $ith 'erson0 Cli'( Ne)t* Pre-i!0+ 1S Tra-el Have you ever been in the -S* Choose +ES or O as applicable (if yes; 'rovide information on your last five -0S0 visits2 %ate of *rrival (dd."".year23 Len/th ! +tay0 Have you ever been issued a -S <isa Choose +ES or O as applicable (if yes; enter details as re=uested 'revious -0S0 <isas %ate 4ast <isa 3as ,ssued; <isa umber) *re you applyin1 for the same type of visa5 *re you applyin1 in the same country $here the visa above $as issued and is this country your principal country of residence5 Have you been ten>printed5 Has your -0S0 <isa ever been lost or stolen5 Has your -0S0 <isa ever been cancelled or revo)ed5 o o

Have you ever been refused a -S <isa5 Choose +ES or O as applicable (if yes; enter details as %%(""(+ear; visa cate1ory of re?ection and from $hich place applied) Re 0+al e),lanati!n Cli'( Ne)t* 1S C!nta't Contact 'erson (4eave &lan) unless )no$n) Surname Given ames0 Or1ani@ation ame (Enter C,EE your -S Sponsor) Relationship to +ou0 *ddress $ith pincode & 'hone of Contact (,f you don't have an address please enter C,EE's address (your -S Sponsor) belo$) Street *ddress 4ine , (788 #ore Street) Street *ddress 4ine 9 City ('ortland) State ("aine) /ip Code (8:686) 'hone umbers A(BBB)9CB>C9:D Email *ddress Cli'( Ne)t* Fa"ily #athers #ull ame $ith date of birth0 DD.MM.4E%R "others #ull ame $ith date of birth0 DD.MM.4E%R

%o you have any immediate relatives in -S*0(Choose +ES or O as applicable) "eans fiancE(fiancEe; spouse (husband($ife); child (son(dau1hter); or siblin1 (brother(sister)0 *lso mention visa type0 %o you have any other relatives in -S*5 Choose +ES or O as applicable) ,f yes then 'rovide the follo$in1 information2 Surnames; Given ames; Relationship to you; Relative's status 0i0e0 citi@en; $or) visa etc0 #amily ,nformation2 Spouse O.E2 Enter current spouse information0 ,f divorced; enter previous spouse information0 Spouse's Surnames; Spouse's Given ames; Spouse's %ate of &irth;%%(""(+E*R Spouse's ationality; Spouse's 'lace of &irth (City and country) Spouse's *ddress

Edit Family Information: Former Spouse(s)

Number of former spouses: Former Spouse's Name (1): Date of Birth: DD/MM/YEAR Former Spouse's Nationa it!: "it! of Birth: "ountr!/Re#ion of Birth:

Date of Marria#e: Date Marria#e En$e$: %o& the Marria#e En$e$:

Country/Region Marriage was Terminated:

Cli'( Ne)t* 5!r(.Ed0'ati!n.Trainin/ 'rimary Occupation0 'resent Employer or School ame0 'resent employer or School address $ith pincode and contact number (Enter details as applicable) "onthly Salary Choose (as applicable)monthly &riefly describe your duties $ith desi1nation Enter (please provide the details) Cli'( Ne)t* Additional Work/Education/Training Information 5ere y!0 ,re-i!0+ly e",l!yed (provide details) E",l!yer.E",l!y"ent In !r"ati!n* E",l!yer Na"e3 E",l!yer %ddre++ C!nta't n!3 S0,eri!r 0ll na"e3 4!0r de+i/nati!n in that '!",any3 4!0r briefly describe your duties $ith desi1nation Enter %*.E O# FO, , G %%(""(+E*R 6Enter 0ll date2 %*.E O# RE4,E<, G %%(""(+E*R2 6Enter 0ll date2 Ha-e y!0 attended any ed0'ati!nal in+tit0ti!n+ at a Se'!ndary le-el !r a7!-e Na"e ! in+tit0ti!n* F0ll %ddre++ ! in+tit0ti!n3 'ity3 +tate #ith 8i, '!de .,r!-in'e3 '!0ntry3 C!0r+e ! +t0dy3 Date ! attendan'e r!"3 DD.MM.4E%R 6Enter 0ll date2 Date ! attendan'e t!* DDMM4E%R 6Enter 0ll date2

Ha-e y!0 tra-eled t! any '!0ntrie+ #ithin the la+t Fi-e year+9 5hi'h '!0ntrie+ D! y!0 7el!n/ t! a 'lan !r tri7e9 'rovide 4ist of 4an1ua1es you spea)5 Have you belon1ed to; contributed to; or $or)ed for any professional; social; or charitable or1ani@ation5 ame of Or1ani@ation (6)2 %o you have any speciali@ed s)ills or trainin1; includin1 firearms; e!plosives; nuclear; biolo1ical; or chemical e!perience5 Have you ever served in the military5 Have you ever served in; been a member of; or been involved $ith a paramilitary unit; vi1ilante unit; rebel 1roup; 1uerrilla 1roup; or insur1ent or1ani@ation5

Cli'( Ne)t* Se'0rity and :a'(/r!0nd "edical & Health ,nformation ('lease ans$er all 7 =uestions .R-.H#-44+) 6)%o you have a communicable disease of public health si1nificance such as tuberculosis (.&)5 9) %o you have a mental or physical disorder that poses or is li)ely to pose a threat to the safety or $elfare of yourself or others5 7) *re you or have you ever been a dru1 abuser or addict5 Cli'( Ne)t* Cri"inal Criminal ,nformation ('lease ans$er all : =uestions .R-.H#-44+) 6) Have you ever been arrested or convicted for any offense or crime; even thou1h sub?ect of a pardon; amnesty; or other similar action5 9) Have you ever violated; or en1a1ed in a conspiracy to violate; any la$ relatin1 to controlled substances5 7) *re you comin1 to the -nited States to en1a1e in prostitution or unla$ful commerciali@ed vice or have you been en1a1ed in prostitution or procurin1 prostitutes $ithin the past 68 years5 :) Have you ever been involved in; or do you see) to en1a1e in; money launderin15 Cli'( Ne)t* Se'0rity Security ,nformation 6) %o you see) to en1a1e in espiona1e; sabota1e; e!port control violations; or any other ille1al activity $hile in the -nited States5

9) %o you see) to en1a1e in terrorist activities $hile in the -nited States or have you ever en1a1ed in terrorist activities5 7) Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist or1ani@ations5 :) *re you a member or representative of a terrorist or1ani@ation5 G) Have you ever ordered; incited; committed; assisted; or other$ise participated in 1enocide5 C) Have you committed; ordered; incited; assisted; or other$ise participated in e!tra?udicial )illin1s; political )illin1s; or other acts of violence5 H) Have you; $hile servin1 as a 1overnment official; been responsible for or directly carried out; at any time; particularly severe violations of reli1ious freedom5 Cli'( Ne)t* I""i/rati!n La# ;i!lati!n+ ,mmi1ration 4a$ <iolations ('lease ans$er the =uestion .R-.H#-44+) Have you ever sou1ht to obtain or assist others to obtain a visa; entry into the -nited States; or any other -nited States immi1ration benefit by fraud or $illful misrepresentation or other unla$ful means5 Cli'( Ne)t* Mi+'ellane!0+ "iscellaneous ,nformation ('lease ans$er all 7 =uestions .R-.H#-44+) 12 Have you ever $ithheld custody of a -0S0 citi@en child outside the -nited States from a person 1ranted le1al custody by a -0S0 court5 &2 Have you voted in the -nited States in violation of any la$ or re1ulation5 <2 Have you ever renounced -nited States citi@enship for the purpose of avoidin1 ta!ation5