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2619/2016 Non-Immigrant vrsa- K6Vl ew l"'efsom;;, !-\UUI =::. , r llV IlC. c , ... , a.> ~i-""' " ,,~•• ,, _ w_. •

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Edit Pers o nal Information

Name Pravided: "

Full Name in Native Alphabet :

Other Nam es Used:

Telecode Name Used:

Sex :

Mari tai Status :

Date cf Birth :

Country/Regio n of Birth :

Country/Region of Orig in (Nationality) :

Do you hold or have you held any nationality other tha n the one indicated above on nati onality ? .

Are you a perma nent resident of a country/ region othe r th an vou r country/region of or igin (nationality) above?

Nati onal Identificat ion Number:

U.S. Soc lal Securi ty Numb er:

U.S. Taxpa yer ID Number:

Ed it Address and Phone Information

Home Address :

City:

State/P rovince:

Postal Zone /ZIP Code :

Country/ Region:

Sam e Mailing Address?

Primary Phone Number: I

Seconda ry Phone Number: I

Work Phone Number:

Email Address:

Ed it Pass Do rt / Travel Doeum ent I nformatio n

Passport/Tra vel oocument Type : I

Passpo rt/Travel Document Number : . I

Passport Book Number : I ~::---;-;::----'--;------------ ­( '

Country / Autho rity that Iss ued Passport(Travel Docume nt : I

City whe re issued : I

State/Province whei e issued :

Country/Regio n where issued :

I ssua nce Date :

Expiration Date:

Have you ever lost a passport or had one stol en?

I ·

htlps://ceac.state.gov/GenNIV/Generallreviewlreview_reviewpersonal.aspx?node=ReviewPersonaJ

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l'iV! :- III1I I It~J 01 u V l ~c.. - l '\.tJV l 'O:'VV I l av~ UliVI I I I Q U V I I

Edit Travel Informatioo

@J The List of Purposes of Trip to the U.S.

Purpose of Tr ip to the U.S. (1):

Specify:

Have you ma de spec ific travel plans?

Provide a complete it inerary for your travel to the U.S.

Date of Arrivai in U.S. :

Arrivai City:

Date of Departure from U.S.:

Departure City : ""A'! -;:--------- _ t~j The Location(s) yo u pian to visit in the U.S.

Location (1):

. Address where you wil l stay in the U.S. :

Person/Entity Paying for Your Trip:

Name of Company/Organization Paying for Tr ip:

Telephone Number:

Relationst)ip to You:

Add ress of Company/Organization Paying: --------------------------- ­

City :

State/Province :

Postal Zone /ZI? Code :

Country/Region:

Ed lt TiC!Vel Camoamons Informatlon

Other Persons Travel ing with You:

Ed it Pre vi o us U.S. Travel Information

!Si Have you ever been in the U.S.?

Date Arrived (1) :

" Length of Stay :

Date Arrived (2) :

Length of Stay :

Date Arrived (3) :

Length of Stay :

Do you or did you ever hoId a U.S. Driver's Ucense?

Have you ever been issued a U.S. v isa?

Have yo u ever been refused a U.S. Vìsa, or been refused adm ission to the United States, or withdrawn your application for adm ission at the port of entry? .

Have you ever been denied t ravel authorizàtion by the Department cf Homeland Security through the Electronic System for Trave! Authorization (ESTA)?

Has anyone ever fi led an im migrant petition on vou r behal f with the United States Citizens hip and Immigration Se rv ices?

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https://ceac.state.gov/GenNIV/General/reviewtreview_reviewtravel.aspx?node=ReviewTravel

Nonìmmlgrsnt Vlsa - Rev !61I1 u <:> vUlU"u. . ... _ •• . . _ _V9/2016

Online Nonimmigrant Visa Application (DS-160) Application ID AA006EUMNO

D.S. Contact Information

Edit U.S . Point of Contact Infonnatio n

Contac t Perso n Name in the U.S. :

Organizat ion Nam e in the U.5 . :

Relationship to You: ,

U.S. Contaet Add ress:

Phone Number:

Email Address:

httos://ceac.state.gov/GenNIVIGeneral/reviewlreviewJ eviewUSCOI1tact.aspx?node=ReviewUSContact 1/1

Nonimmigrant Visa - Revlew r-allluy "uV""Ww ~" .61912016

Application fD AA006EUMNO Online Nonimmigrant Visa Application (DS-160)

Family Infonnation

Edit Familv Infonnatio n ' Re latives

Father 's Surn ames:

Father's Give n Narnes:

Father 's Date of Birth :

Is your fath er in the U.s.?

Mother's Surn ames :

Mother's Given Nam es:

Mother's Date of Birth :

Is your mo the r in th e U.S.?

Do you have any im mediate re latives, n';;o:i='t Trin:;;c:j,lu;-;;d;nl;;'n';;' a:;:;;n ----------g -;:p;;; re n1ts~innttt'hh;;,e --1 U.S.?

Do you have any othe r relatives in, th e United Sta tes?

Edit Family Informati on: Spouse

5pouse's Full Name:

Spouse's Date of Birth:

Spouse's Country/Region of Orig in (Na 'onality ) :

Spouse's City of Birth:

Spouse's Country/Region of Birth :

Spou se's Address:

nttn<.-I/r.p.;lc.state.aov/GenNIV/General/revifNilreview_revieNFamiIy.aspx?node=ReviewFamily 1/1

26/9/2016 NonimmigrantVisa- Review VVOf K , c:lU U" " ,.... . .._- - ..r:U U " U

Edit Present Work Information

Primary Occupation:

Specify Other:

Present Employer or School Name :

Present Employer or School Address:

City :

State/Province :

Postal Zone/Zip Code:

Country/ Region:

Work Phone Number: . Monthly Salary in Lo c~1 Currency (if em ployed):

----------~----------Briefly Descr ibe your Duties : Ed it Previous Wo rk Information

Were you previously employed?

[é=] Have you attended any educa-ti-'o-n-a-l-in-S-ti-·t-u-t i-o-n-s-a-t-a-se-c-o-n-.d-a-r-y----.;-----:---- ­

level or above?

Name of I nstituti on (1) :

Addressof I nsti t uti on:

City :

State/Province :

Postal Zone/ZIP Code :

Country/Reg ion:

Course of Study:

Date of Attendance From:

Date of Atte ndance To:

Edit Add it io na l Information

Do you belong to a clan or tribe?

~ Pre vide a List of Languages You Speak :

Language Name (1):

~ Have you traveled to any countries/regions within the last five yea rs?

Prov ide a Ust of Countries/Reg ions Vis ited

Country /Reg ion(l) : - I ._ .. - ­

Country/Region(2):

CoUntry/Reg ion (3):

Have you belonged to , contributed to, or work ed for any professiona l, socìa l, or charita ble organization? --

Do you have any specialized sk ills or tra ining, such as firearms, VES NO exp losive s, nuclear, biologica I, or chem ical experience? VES NO Have you eve r served in the military? VES NO Have you ever serv ed in, been a member of, or been invo!ved wtth a VES NO paramilitary unlt, vigilante unlt, rebel group, guerr illa group, or insurgent organization?

httDs:llceac.state.gov/GenNIV/GenerallreviewlreviewJeviewWorkEducation.aspx?node=ReviewWorkEducation 212

NonimmigrantVisa - KeVlew """,",u"'l . 000_0 • • • _ .619/2016

Online Nonimmigrant Visa Application (DS-160) Appl ica tion io AA006EUMNO

Security and Background Infonnation

Do vo u have a communicable d isease of public hea lth sign ifica nce? (Comm unicable diseases of pub llc signifi cance inclu de chancroid, gono r rhea , gra nuloma inguinale, inf ecti ous leprosy, Iv mph ogranuloma venereum, infecti ous stage sy ph ilis, active tuberculos is, and cther disea ses as determined bv the Department or Health and Hum an Serv ices. )

Do vou have a mental or physical disorder th at poses or is lìkelv to pose a th reat to th e safetv or welfare or yourself or others?

Are yo u or have you ever been a drug abuser or addict?

Have vou ever been arrested or conv icted for anv offense or cr ime, ev en though subj ect of a pardon, amnesty, or other sim ilar aetion?

Have you ever v iolated, or engaged in a conspiracv to violate, anv law relat ing to controlled substances?

Are vou coming to the United States to eng age in prostit ut ion or un!awful commercia lized v ice or have vou be en engaged in prosti t uti on or procuri ng pros tìtutes within the past 10 vea rs?

Have you eve r been lnvolved in, or do you see k to enga ge in, money laundering?

Have you ever committed or conspired te commit a human trafficking offense in the Unite d Sta tes or outside the United States?

Are you the spouse, son, or daughter of an ind iv iduai wh o has comm itted or conspired to commit a hum an trafficking offense in th e United Sta tes or outside th e United Sta tes and have vou within th e last fi ve years, knowìnqlv benefited from the trafficking acti viti es?

Have you kno wlnq ly aided, abetted, assisted or coilud ed w ith an individuai who has committed or conspired to commit a severe human trafficking offense in th e United States or outs ide the United States?

Do vou seek to engage in espionage, sabotage , export contro l viol ati ons, or anv other ill egal activity wh ile in th e United Sta tes?

Do vou see k te engage in terroris t activities whil e in the United Sta tes or have you eve r engaged in terrorist acti v ities?

Have you ever or do vou intend to provide fin ancial ass ista nce or other support to te rro r ists or terrorist organizations?

Are vou a member or representative of a terrorist orçanlzatìo n?

Have you ever ordered, incited, committed , assisted, or otherwise participated in genocide?

Have vou eve r committed, ordered, incited, ass isted, or oth erwise parti cipated in torture?

Have vou committed, orde red, incited, ass isted, or oth erwise parti cipa te d in extrajudicial killings, po liti caI k ill ings, or other acts of violence?

Have vou ever engaged in the recruitment or th e use of the child so ld iers?

Have you, wh ile serving as a government offidaI, been resp onsible for or directl y car r ied out, at anv t ime, partìcula rlv severe violatio ns of reli gi ous freedom?

Have vou ever been directly involved in the establishment or enforcement of the population controls forcing a woman to und ergo an ab ortion aga inst her free choi ce or a man or a woman to undergo sterilization aga inst his or her free will?

Have vou ever been directly involved in th e coerclve transpl antation of human organs or bodilv t issue?

Have you ever been the subject of a rem oval or dep ortat ion hearln ç?

httn<;:/lceac.state.QOV/GenNNlGenerallrevieNlreviEINJevievv'security.aspx?oode=ReviElNSecurity

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Ed it Part 1

VES NO VES NO VES NO

Ed it Part 2

VES NO VES NO.1 VES NO VES NO VES NO VES

~

NO VES NO ,

Ed it Part 3

VES NO VES !NO VES NO VES NO VES NO VES NO VES NO VES · NO VES NO VES NO VES NO

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Edit Part 4

112

Nonimmigrant Visa - Review Secunty Irnormauofl 261912016

Have you everso~1»Jil? q,biPA~aw!lt.Pij;lfl{ij;Q.~I"I.~~~~ ~iO;;,Q~ l.I~e~r. any other United 51i1tWinWUtl :mDNfi.INf43udlo "ilfmtm il~e~~tt~ · I r:RVIE unlawful means?

Have you fail ed to attend a heari ng on removabili ty or inadmissibility with in the last fiv e years?

Have you ever been unlawfully present, ove rstayed the amount of tim e granted by an imm igration offi daI or otherwise violated th e term s of a U.S. v isa?

Edit Perì 5

Have you ever with held custody of a U.S. cit izen chl ld outside the United States from a person granted legai custody by a U.S. court? VES NO

Have yo u voted in the United Sta tes in violat ion of any law or regu lation? VES NO

Have you ever renoun ced United States citizenship for the purpose of avo iding taxation? VES NO

VES NOHave you attended a public eleme nta ry schoo l on student CF) status or a publi c secondary school 1.....-.- __ 1. _ -after November 3D, 1996 with out reimbursing the school?

httn.c;:lfceac.state.QOv/GenNIV/Generallreview/reviewJeviewsecurity.aspx?ncde=RerviewSecurity 212

Online Nonirnmigrant Visa Application (DS-160) Appli cation ID AA006EUMNO

Location Information

Edit Location Information

Location where you will be submitting your appiication

Current Location: ROMA

MILAN_O,

FIRENZE

'";

NApOLI

https://ceac.state.gov/GenNIV/General/review/review_reviewlocation.aspx?node=ReviEN'JLocation 1/1