K1 Visa Application Assistance Form

All fields are required.

If a field does not apply, please enter the value of "NA".

If a field is unknown, please enter the value of "unknown".

Your Information

Family Name First Name Middle Name

Birth Date (MM/DD/YY)

Nationality

All Other Names Used

City and Country of Birth

Social Security No. (if any)

Information About Your Father

Father's Family Name Father's First Name Father's Middle Name

Father's Date of Birth Father's City & Country of Birth Father's City & Country of Residence

Information About Your Mother

Mother's Family Name Mother's First Name Mother's Middle Name

Mother's Date of Birth Mother's City & Country of Birth Mother's City & Country of Residence

Information About Your Current Wife

Wife's Family Name
Wife's First Name

Wife's Date of Birth Date & Place of Marriage Date & Place of Termination of Marriage

No Wife

Your Information (Continued)

10:

Your Residence for the last five years, List Present Address First;
Street and Number, City, Province or State, Country,
From (Month and Year) to (Month and Year).

11:

Your Employment Last Five Years (if none, so state), List Present Employment First; Full Name and Address of Employer, Occupation (specify), From (Month and Year) to (Month and Year)

12:

Name: Family Name in (CAPS), First, Middle:

13:

Address (Number and Street); Apt. #; Town or City; State, Country, Zip Postal Code

14:

Place of Birth (Town or City) (State/Country)

15:

Date of Birth (mm/dd/yyyy)

16:

Gender

Male

17:

Marital Status

Single Unmarried Never Been Married

18:

Other Names Used (Including Maiden Name)

19:

Social Security No.

20:

Names of Prior Spouses; Date(s) Marriage(s) Ended
Not Applicable; Never Married

21:

My Citizenship was acquired through (check one):

Birth in the US Naturalization Parents

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