This document contains a visa application with questions regarding personal information, travel plans, education/employment history, and relationships to individuals in the United States. The applicant's name is Md Abul Kashem Chowdhury and he intends to travel to the US to study. His father, located in Bangladesh, will financially support the trip. The applicant provides details about his passport, addresses, schools attended, languages spoken, countries visited, and plans to study in the US.

1. 1. What is the purpose of your trip?
Study
2. Full Name (As in Passport) & Passport Number:
 Have you ever used other names? (i.e. maiden ,religious, professional etc.)

3. Marital Status: (Married/Single/Widowed/Divorced/Separated):
4. National Identification Number (If Applicable):
 Do you hold or have you held any nationality other than the one indicated? (Givethe
Nationality and the Passport No.)
 U.S. Social Security Number. (If Applicable)
 U.S. Taxpayer ID Number. (If Applicable)
5. Home Address (Present) & Mailing Address.
6. Telephone Number. (Home/Mobile/Business)
7. E-mail Address. (If Applicable)
8.
9. When do you intend to arrive in the U.S.?
10. How long do you intend to stay in the U.S.?
11. At what address will you stay in the U.S.?

2. 12. Who will pay for your trip? Give the Name, Relation, Address & Phone Number.
Md Abul Kashem Chowdhury
Relationship: Father
13. Names and relationships of persons travelling with you. (If Applicable)
14. Have you ever been in the U.S.? When (Date of Arrival) for how long? ( Last five U.S. visit)
 U.S. Drivers License Number and State of Drivers license. (If Applicable)
15. Have you ever been issued a U.S. visa? (If YES give Date last visa was issued, Visa class and
Visa Number(8 digits)
16. Have you ever been Lost/refused/cancelled/revoked a U.S. visa? When? Where? Whattype
of Visa? (If Applicable)
 Has anyone ever filed an immigrant petition on your behalf with the UnitedStates
Citizenship and Immigration Services? Explain
17. Full Name and Address and Relationship of Contact Person or Organization in the U.S.
(Include Zip code, Telephone Number and E-mail)

3. 18. Father’s Full Name and Date of Birth.
19: Mother’s Full Name and Date of Birth.
20. Are any of the following person sin the U.S.? (Father/Mother, Son/Daughter, Husband/Wife,
Brother/ Sister, fiancé/Fiancée). If Yes Give the Name, Relation and Status. (i.e. LPR. U.S. citizen,
studying, working etc.)
 Do you have any other relatives in the United States? Yes/No
21. Spouse Full Name, Place & date of Birth. (If Applicable)
22. Names, Address and Phone Number of Present Employer or School.
23. Monthly Salary in Local Currency & Designation.
24. Provide your employment information for the last five years, if applicable. Give Last Two
EmployerName,Address,TelephoneNumber,JobTitle,Supervisor’sName,datesof
Employment (dd/mm/yyyy- dd/mm/yyyy).

4. Institution Name Address
Supervisors Name
Duration designation
Contact
number
25. List all educational institutions you attend or have attended. (If Applicable). Give the Name
of Institutions you attend or have attended (If Applicable). Give the Name of Institutions,
Address, Course of Study and Dates of Attendance (dd/mm/yyyy-dd/mm/yyyy).
SSC-
HSC-
HONOURS-
MASTERS-
26. Provide a list of languages you speak (Language name).

5. 27. List all countries you have entered in the last five years (Country Names Only).
28. List all Professional, Social and Charitable organizations to which you belong.
29. Do you have any specialized skills or training firearms? If yes please explain.
30. Have you ever performed military service? Give the Branch, Rank, Specialty and Dates of
Service.
31. List two contacts in Applicants Country of residence who can verify information about
applicant (Do not list immediate family members or other relatives)/ Give Address and Phone
Number.
32. Do you Intend to study in the U.S.? If yes give the course of Study, name and complete
address of the school.
33. Do you intend to work in the U.S.? If yes gives the name, complete address of the U.S.
employer and Monthly salary (in USD).
34. Name of Person/ Company who filed petition. Give Application/petition number.
35. Crew Information (Vessel/Aircraft)
 Job title, Company Name, Company Telephone number, Agency Name, Contactperson,
Address, Phone Number, Vessel name and Identification number.