Foreign Address (including post code):

Foreign Address (including post code): 142181 Russia, Klimovsk US Consulate/Embassy abroad at which you wish to apply for your visa: United States Address (if any): United States Social Security Number (if any): Have you ever had an 0-1 visa? If so, which agency or agencies served as the petitioner (visa sponsor)? no Have you ever had an H-1B or 1-1 visa, or any other US visa issued to you? no Have you ever had a US visa application denied, a US visa revoked, or have you been denied entry into the US? If yes, please explain. no Has anyone (including yourself, a family member, spouse or employer) ever filed a Green Card application for you? ng Have you ever been arrested, charged with or convicted of a criminal offence (whether in the US or in any other country)? If yes, please provide details. no Do you have any dependents (spouse and/ or child(ren))? If yes, please provide details. mi Please also provide copies of the following: • Color copy of your passport biographic data page (page with your photo). • Copies of ALL current and past USCIS Approval Notices for ALL non-immigrant (B-2, H-1B, 0-1, etc.) visas. • Copies of ALL current and past non-immigrant (B-2, F, H-1B, E, L, 0-1, etc.) vita 'tamps in your current gag expired passports. This the page affixed into your passport by EFTA00313675