365 Visa Application Center

1. Core Identification & Contact

1. Email Address *

2. Name *

3. Current Home Address (if differ from passport) *

4. city name *

5. pincode *

6. e mail id *

7. Primary Phone Number *

8. home Phone Number *

9. work phone number *

10. Have you used additional email addresses in the last five years? (NA IF NOT APPLICABLE) *

11. Social Media Profile Breakdown

Social Media Platform Name (NA IF NOT APPLICABLE) *

Social Media User ID / Handle (NA IF NOT APPLICABLE) *

2. US Travel Info & Background

12. Have you ever been issued a U.S. visa? (if yes provide visa copy in scan document) (NA IF NOT APPLICABLE) *

yes no

13. U.S. Visa Refusal Details

Have you ever been refused a U.S. Visa? *

Date & Reason of Rejection (NA IF NOT APPLICABLE) *

14. Previous U.S. Visits Logging

Date of Past Entry into USA (NA IF NOT APPLICABLE) *

Length of Stay in USA (NA IF NOT APPLICABLE) *

Family Information

15. Father's Date of Birth: *

16. mother's Date of Birth: *

17. Immediate Relatives in the U.S. Breakdown (Excluding Parents)

Relative Full Name (NA IF NOT APPLICABLE) *

Relationship to You (NA IF NOT APPLICABLE) *

Relative US Home Street Address (NA IF NOT APPLICABLE) *

Relative US Zip/Pincode (NA IF NOT APPLICABLE) *

Relative US Phone No (NA IF NOT APPLICABLE) *

Relative Legal Status in USA (e.g. Citizen, Work Visa, Student Visa) (NA IF NOT APPLICABLE) *

Spouse Details (If Applicable)

18. Spouse's Date of Birth

19. Spouse's place of Birth:

3. Work & Education Info

20. Primary Occupation: (like doctor, engineer, teacher, businessman) *

21 & 22. Current Workplace / School Specifications

Present Employer or School Name (MENTION IF SELF EMPLOYED) *

Street Address *

City Name *

Pincode *

Present Employer/School Started Month & Year *

23. Briefly Describe your Duties: (for student mention current standard) *

24. Previous Employment Data (Last 15 Years Only)

Previous Employer Name (NA IF NOT APPLICABLE) *

Your Designation / Role (NA IF NOT APPLICABLE) *

Employer Address & Pincode (NA IF NOT APPLICABLE) *

Employer Phone No (NA IF NOT APPLICABLE) *

Supervisor Name (NA IF NOT APPLICABLE) *

Started (MM/YY) (NA IF NOT APPLICABLE) *

Completed (MM/YY) (NA IF NOT APPLICABLE) *

25. Educational Institutions attended (Secondary Level (12th) or Above)

Name of Institution (for graduate mention bachelor) *

City *

Pincode *

Degree / Stream Name *

Started & Completed MM/YY *

26. Educational Institutions attended (Master's Degree level - LIKE MD, MS, MSC, MCOM, MA)

Name of Institution (NA IF NOT APPLICABLE) *

City (NA IF NOT APPLICABLE) *

Pincode (NA IF NOT APPLICABLE) *

Degree Name (NA IF NOT APPLICABLE) *

Started & Completed MM/YY (NA IF NOT APPLICABLE) *

Background Credentials

27. LANGUAGE KNOWN (LIKE ENGLISH, HINDI GUJARATI, FRENCH. ETC) *

28. Provide a List of Countries/Regions Visited. *

4. Required Document Submissions

29. ITR ASSESSMENT COPY, PASSPORT FRONT AND BACK COPY.

Upload Verification Area *

Select your PDF/Images to upload

Attach documents directly inside WhatsApp after redirection

365 USA VISA FORM