* 2. WILL YOU BRING A SPOUSE OR CHILD WITH YOU?
* List dependents who will be applying for F-2 Visa and traveling with you. Include
a copy of passport photo page for each dependent.
1. Spouse/Child Name as in Passport:
* 2. Date of Birth:
Month:
January
February
March
April
May
June
July
August
September
October
November
December
Day:
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Year:
2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940
* 3. City of Birth:
* 4. Country of Birth:
";
Afghanistan Akrotiri Albania Algeria American Samoa (COB) Andorra Angola Anguilla Antarctica (COB,PIC) Antigua and Barbuda Argentina Armenia Aruba (Netherlands) Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island (COB) Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canal Zone (COB) Canton and Enderbury (COB,PIC) Cape Verde Cayman Islands Central African Republic Central and Southern Line Islands (COB,PIC) Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo (Kinshasa) Congo, Republic of The Cook Islands Coral Sea Islands Costa Rica Cote D Ivoire Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Democratic Republic of Viet Nam (COB,PIC) Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Etorofu, Habomai, Kunashiri, and Shikotan Islands Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Federal Republic of Germany (COB,PIC) Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands French Territory of the Afars and Issas (COB,PIC) Gabon Gambia, The Gaza Strip Georgia German Democratic Republic (COB,PIC) Germany Germany, Berlin (COB) Ghana Gibraltar Gilbert and Ellice Islands (COB,PIC) Gilbert Islands (COB,PIC) Glorioso Islands Greece Greenland Grenada Guadeloupe Guam (COB) Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Honduras Hong Kong Howland Island (COB) Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Arabia Neutral Zone (COB,PIC) Ireland Isle of Man Israel Israel-Jordan Demilitarized Zone (COB,PIC) Israel-Syria Demilitarized Zone (COB,PIC) Italy Jamaica Jan Mayen Japan Jarvis Island (COB) Jersey Johnston Atoll (COB) Jordan Juan De Nova Island Kazakhstan Kenya Kingman Reef (COB) Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands (COB) Moldova Monaco Mongolia Montenegro Montenegro (Prior to 2001) Montserrat Morocco Mozambique Namibia Nauru Navassa Island (COB) Nepal Netherlands Netherlands Antilles (COB) Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (COB) Norway Oman Pakistan Palau Palmyra Atoll (COB) Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Portuguese Timor (COB,PIC) Puerto Rico (COB) Qatar Republic of Viet Nam (COB,PIC) Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension, and Tristan Da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre and Miquelon Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia (Prior to 2001) Serbia and Montenegro (COB, PIC) Seychelles Sierra Leone Sikkim (COB,PIC) Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands South Korea South Sudan Southern Rhodesia (COB,PIC) Southern Ryukyu Islands (COB,PIC) Spain Spanish North Africa (COB,PIC) Spanish Sahara (COB,PIC) Spratly Islands Sri Lanka St. Lucia St. Vincent and The Grenadines Stateless Sudan Suriname Svalbard Svalbard and Jan Mayen (COB,PIC) Swan Islands (COB,PIC) Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Trust Territory of the Pacific Islands (COB,PIC) Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom United States (COB) United States Misc. Pacific Islands (COB,PIC) Unknown Uruguay USSR Uzbekistan Vanuatu (Nbds,nheb) Vatican City Venezuela Vietnam Virgin Islands (COB) Wake Island (COB) Wallis and Futuna West Bank Western Sahara Yeman (Sanaa) (COB,PIC) Yemen Yemen (Aden) (COB,PIC) Yugoslavia (COB,PIC) Zambia Zimbabwe
* 5.Country of Citizenship:
";
Afghanistan Akrotiri Albania Algeria American Samoa (COB) Andorra Angola Anguilla Antarctica (COB,PIC) Antigua and Barbuda Argentina Armenia Aruba (Netherlands) Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island (COB) Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canal Zone (COB) Canton and Enderbury (COB,PIC) Cape Verde Cayman Islands Central African Republic Central and Southern Line Islands (COB,PIC) Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo (Kinshasa) Congo, Republic of The Cook Islands Coral Sea Islands Costa Rica Cote D Ivoire Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Democratic Republic of Viet Nam (COB,PIC) Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Etorofu, Habomai, Kunashiri, and Shikotan Islands Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Federal Republic of Germany (COB,PIC) Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands French Territory of the Afars and Issas (COB,PIC) Gabon Gambia, The Gaza Strip Georgia German Democratic Republic (COB,PIC) Germany Germany, Berlin (COB) Ghana Gibraltar Gilbert and Ellice Islands (COB,PIC) Gilbert Islands (COB,PIC) Glorioso Islands Greece Greenland Grenada Guadeloupe Guam (COB) Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Honduras Hong Kong Howland Island (COB) Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Arabia Neutral Zone (COB,PIC) Ireland Isle of Man Israel Israel-Jordan Demilitarized Zone (COB,PIC) Israel-Syria Demilitarized Zone (COB,PIC) Italy Jamaica Jan Mayen Japan Jarvis Island (COB) Jersey Johnston Atoll (COB) Jordan Juan De Nova Island Kazakhstan Kenya Kingman Reef (COB) Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands (COB) Moldova Monaco Mongolia Montenegro Montenegro (Prior to 2001) Montserrat Morocco Mozambique Namibia Nauru Navassa Island (COB) Nepal Netherlands Netherlands Antilles (COB) Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (COB) Norway Oman Pakistan Palau Palmyra Atoll (COB) Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Portuguese Timor (COB,PIC) Puerto Rico (COB) Qatar Republic of Viet Nam (COB,PIC) Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension, and Tristan Da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre and Miquelon Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia (Prior to 2001) Serbia and Montenegro (COB, PIC) Seychelles Sierra Leone Sikkim (COB,PIC) Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands South Korea South Sudan Southern Rhodesia (COB,PIC) Southern Ryukyu Islands (COB,PIC) Spain Spanish North Africa (COB,PIC) Spanish Sahara (COB,PIC) Spratly Islands Sri Lanka St. Lucia St. Vincent and The Grenadines Stateless Sudan Suriname Svalbard Svalbard and Jan Mayen (COB,PIC) Swan Islands (COB,PIC) Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Trust Territory of the Pacific Islands (COB,PIC) Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom United States (COB) United States Misc. Pacific Islands (COB,PIC) Unknown Uruguay USSR Uzbekistan Vanuatu (Nbds,nheb) Vatican City Venezuela Vietnam Virgin Islands (COB) Wake Island (COB) Wallis and Futuna West Bank Western Sahara Yeman (Sanaa) (COB,PIC) Yemen Yemen (Aden) (COB,PIC) Yugoslavia (COB,PIC) Zambia Zimbabwe
* 6. Gender
Female
Male
* 7. Relationship
spouse
daughter
son
* 8. Please, include a copy of passport photo page this dependent
Do You Want to Add Another Dependent?
1. Spouse/Child Name as in Passport:
* 2. Date of Birth:
Month:
January
February
March
April
May
June
July
August
September
October
November
December
Day:
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Year:
2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940
* 3. City of Birth:
* 4. Country of Birth:
";
Afghanistan Akrotiri Albania Algeria American Samoa (COB) Andorra Angola Anguilla Antarctica (COB,PIC) Antigua and Barbuda Argentina Armenia Aruba (Netherlands) Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island (COB) Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canal Zone (COB) Canton and Enderbury (COB,PIC) Cape Verde Cayman Islands Central African Republic Central and Southern Line Islands (COB,PIC) Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo (Kinshasa) Congo, Republic of The Cook Islands Coral Sea Islands Costa Rica Cote D Ivoire Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Democratic Republic of Viet Nam (COB,PIC) Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Etorofu, Habomai, Kunashiri, and Shikotan Islands Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Federal Republic of Germany (COB,PIC) Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands French Territory of the Afars and Issas (COB,PIC) Gabon Gambia, The Gaza Strip Georgia German Democratic Republic (COB,PIC) Germany Germany, Berlin (COB) Ghana Gibraltar Gilbert and Ellice Islands (COB,PIC) Gilbert Islands (COB,PIC) Glorioso Islands Greece Greenland Grenada Guadeloupe Guam (COB) Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Honduras Hong Kong Howland Island (COB) Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Arabia Neutral Zone (COB,PIC) Ireland Isle of Man Israel Israel-Jordan Demilitarized Zone (COB,PIC) Israel-Syria Demilitarized Zone (COB,PIC) Italy Jamaica Jan Mayen Japan Jarvis Island (COB) Jersey Johnston Atoll (COB) Jordan Juan De Nova Island Kazakhstan Kenya Kingman Reef (COB) Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands (COB) Moldova Monaco Mongolia Montenegro Montenegro (Prior to 2001) Montserrat Morocco Mozambique Namibia Nauru Navassa Island (COB) Nepal Netherlands Netherlands Antilles (COB) Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (COB) Norway Oman Pakistan Palau Palmyra Atoll (COB) Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Portuguese Timor (COB,PIC) Puerto Rico (COB) Qatar Republic of Viet Nam (COB,PIC) Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension, and Tristan Da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre and Miquelon Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia (Prior to 2001) Serbia and Montenegro (COB, PIC) Seychelles Sierra Leone Sikkim (COB,PIC) Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands South Korea South Sudan Southern Rhodesia (COB,PIC) Southern Ryukyu Islands (COB,PIC) Spain Spanish North Africa (COB,PIC) Spanish Sahara (COB,PIC) Spratly Islands Sri Lanka St. Lucia St. Vincent and The Grenadines Stateless Sudan Suriname Svalbard Svalbard and Jan Mayen (COB,PIC) Swan Islands (COB,PIC) Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Trust Territory of the Pacific Islands (COB,PIC) Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom United States (COB) United States Misc. Pacific Islands (COB,PIC) Unknown Uruguay USSR Uzbekistan Vanuatu (Nbds,nheb) Vatican City Venezuela Vietnam Virgin Islands (COB) Wake Island (COB) Wallis and Futuna West Bank Western Sahara Yeman (Sanaa) (COB,PIC) Yemen Yemen (Aden) (COB,PIC) Yugoslavia (COB,PIC) Zambia Zimbabwe
* 5.Country of Citizenship:
";
Afghanistan Akrotiri Albania Algeria American Samoa (COB) Andorra Angola Anguilla Antarctica (COB,PIC) Antigua and Barbuda Argentina Armenia Aruba (Netherlands) Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island (COB) Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canal Zone (COB) Canton and Enderbury (COB,PIC) Cape Verde Cayman Islands Central African Republic Central and Southern Line Islands (COB,PIC) Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo (Kinshasa) Congo, Republic of The Cook Islands Coral Sea Islands Costa Rica Cote D Ivoire Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Democratic Republic of Viet Nam (COB,PIC) Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Etorofu, Habomai, Kunashiri, and Shikotan Islands Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Federal Republic of Germany (COB,PIC) Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands French Territory of the Afars and Issas (COB,PIC) Gabon Gambia, The Gaza Strip Georgia German Democratic Republic (COB,PIC) Germany Germany, Berlin (COB) Ghana Gibraltar Gilbert and Ellice Islands (COB,PIC) Gilbert Islands (COB,PIC) Glorioso Islands Greece Greenland Grenada Guadeloupe Guam (COB) Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Honduras Hong Kong Howland Island (COB) Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Arabia Neutral Zone (COB,PIC) Ireland Isle of Man Israel Israel-Jordan Demilitarized Zone (COB,PIC) Israel-Syria Demilitarized Zone (COB,PIC) Italy Jamaica Jan Mayen Japan Jarvis Island (COB) Jersey Johnston Atoll (COB) Jordan Juan De Nova Island Kazakhstan Kenya Kingman Reef (COB) Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands (COB) Moldova Monaco Mongolia Montenegro Montenegro (Prior to 2001) Montserrat Morocco Mozambique Namibia Nauru Navassa Island (COB) Nepal Netherlands Netherlands Antilles (COB) Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (COB) Norway Oman Pakistan Palau Palmyra Atoll (COB) Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Portuguese Timor (COB,PIC) Puerto Rico (COB) Qatar Republic of Viet Nam (COB,PIC) Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension, and Tristan Da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre and Miquelon Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia (Prior to 2001) Serbia and Montenegro (COB, PIC) Seychelles Sierra Leone Sikkim (COB,PIC) Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands South Korea South Sudan Southern Rhodesia (COB,PIC) Southern Ryukyu Islands (COB,PIC) Spain Spanish North Africa (COB,PIC) Spanish Sahara (COB,PIC) Spratly Islands Sri Lanka St. Lucia St. Vincent and The Grenadines Stateless Sudan Suriname Svalbard Svalbard and Jan Mayen (COB,PIC) Swan Islands (COB,PIC) Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Trust Territory of the Pacific Islands (COB,PIC) Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom United States (COB) United States Misc. Pacific Islands (COB,PIC) Unknown Uruguay USSR Uzbekistan Vanuatu (Nbds,nheb) Vatican City Venezuela Vietnam Virgin Islands (COB) Wake Island (COB) Wallis and Futuna West Bank Western Sahara Yeman (Sanaa) (COB,PIC) Yemen Yemen (Aden) (COB,PIC) Yugoslavia (COB,PIC) Zambia Zimbabwe
* 6. Gender
Female
Male
* 7. Relationship
spouse
daughter
son
* 8. Please, include a copy of passport photo page this dependent
Do You Want to Add Another Dependent?
1. Spouse/Child Name as in Passport:
* 2. Date of Birth:
Month:
January
February
March
April
May
June
July
August
September
October
November
December
Day:
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Year:
2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940
* 3. City of Birth:
* 4. Country of Birth:
";
Afghanistan Akrotiri Albania Algeria American Samoa (COB) Andorra Angola Anguilla Antarctica (COB,PIC) Antigua and Barbuda Argentina Armenia Aruba (Netherlands) Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island (COB) Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canal Zone (COB) Canton and Enderbury (COB,PIC) Cape Verde Cayman Islands Central African Republic Central and Southern Line Islands (COB,PIC) Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo (Kinshasa) Congo, Republic of The Cook Islands Coral Sea Islands Costa Rica Cote D Ivoire Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Democratic Republic of Viet Nam (COB,PIC) Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Etorofu, Habomai, Kunashiri, and Shikotan Islands Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Federal Republic of Germany (COB,PIC) Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands French Territory of the Afars and Issas (COB,PIC) Gabon Gambia, The Gaza Strip Georgia German Democratic Republic (COB,PIC) Germany Germany, Berlin (COB) Ghana Gibraltar Gilbert and Ellice Islands (COB,PIC) Gilbert Islands (COB,PIC) Glorioso Islands Greece Greenland Grenada Guadeloupe Guam (COB) Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Honduras Hong Kong Howland Island (COB) Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Arabia Neutral Zone (COB,PIC) Ireland Isle of Man Israel Israel-Jordan Demilitarized Zone (COB,PIC) Israel-Syria Demilitarized Zone (COB,PIC) Italy Jamaica Jan Mayen Japan Jarvis Island (COB) Jersey Johnston Atoll (COB) Jordan Juan De Nova Island Kazakhstan Kenya Kingman Reef (COB) Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands (COB) Moldova Monaco Mongolia Montenegro Montenegro (Prior to 2001) Montserrat Morocco Mozambique Namibia Nauru Navassa Island (COB) Nepal Netherlands Netherlands Antilles (COB) Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (COB) Norway Oman Pakistan Palau Palmyra Atoll (COB) Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Portuguese Timor (COB,PIC) Puerto Rico (COB) Qatar Republic of Viet Nam (COB,PIC) Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension, and Tristan Da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre and Miquelon Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia (Prior to 2001) Serbia and Montenegro (COB, PIC) Seychelles Sierra Leone Sikkim (COB,PIC) Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands South Korea South Sudan Southern Rhodesia (COB,PIC) Southern Ryukyu Islands (COB,PIC) Spain Spanish North Africa (COB,PIC) Spanish Sahara (COB,PIC) Spratly Islands Sri Lanka St. Lucia St. Vincent and The Grenadines Stateless Sudan Suriname Svalbard Svalbard and Jan Mayen (COB,PIC) Swan Islands (COB,PIC) Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Trust Territory of the Pacific Islands (COB,PIC) Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom United States (COB) United States Misc. Pacific Islands (COB,PIC) Unknown Uruguay USSR Uzbekistan Vanuatu (Nbds,nheb) Vatican City Venezuela Vietnam Virgin Islands (COB) Wake Island (COB) Wallis and Futuna West Bank Western Sahara Yeman (Sanaa) (COB,PIC) Yemen Yemen (Aden) (COB,PIC) Yugoslavia (COB,PIC) Zambia Zimbabwe
* 5.Country of Citizenship:
";
Afghanistan Akrotiri Albania Algeria American Samoa (COB) Andorra Angola Anguilla Antarctica (COB,PIC) Antigua and Barbuda Argentina Armenia Aruba (Netherlands) Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island (COB) Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canal Zone (COB) Canton and Enderbury (COB,PIC) Cape Verde Cayman Islands Central African Republic Central and Southern Line Islands (COB,PIC) Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo (Kinshasa) Congo, Republic of The Cook Islands Coral Sea Islands Costa Rica Cote D Ivoire Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Democratic Republic of Viet Nam (COB,PIC) Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Etorofu, Habomai, Kunashiri, and Shikotan Islands Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Federal Republic of Germany (COB,PIC) Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands French Territory of the Afars and Issas (COB,PIC) Gabon Gambia, The Gaza Strip Georgia German Democratic Republic (COB,PIC) Germany Germany, Berlin (COB) Ghana Gibraltar Gilbert and Ellice Islands (COB,PIC) Gilbert Islands (COB,PIC) Glorioso Islands Greece Greenland Grenada Guadeloupe Guam (COB) Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Honduras Hong Kong Howland Island (COB) Hungary Iceland India Indonesia Iran Iraq Iraq-Saudi Arabia Neutral Zone (COB,PIC) Ireland Isle of Man Israel Israel-Jordan Demilitarized Zone (COB,PIC) Israel-Syria Demilitarized Zone (COB,PIC) Italy Jamaica Jan Mayen Japan Jarvis Island (COB) Jersey Johnston Atoll (COB) Jordan Juan De Nova Island Kazakhstan Kenya Kingman Reef (COB) Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands (COB) Moldova Monaco Mongolia Montenegro Montenegro (Prior to 2001) Montserrat Morocco Mozambique Namibia Nauru Navassa Island (COB) Nepal Netherlands Netherlands Antilles (COB) Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands (COB) Norway Oman Pakistan Palau Palmyra Atoll (COB) Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Portuguese Timor (COB,PIC) Puerto Rico (COB) Qatar Republic of Viet Nam (COB,PIC) Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension, and Tristan Da Cunha Saint Kitts and Nevis Saint Martin Saint Pierre and Miquelon Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia (Prior to 2001) Serbia and Montenegro (COB, PIC) Seychelles Sierra Leone Sikkim (COB,PIC) Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands South Korea South Sudan Southern Rhodesia (COB,PIC) Southern Ryukyu Islands (COB,PIC) Spain Spanish North Africa (COB,PIC) Spanish Sahara (COB,PIC) Spratly Islands Sri Lanka St. Lucia St. Vincent and The Grenadines Stateless Sudan Suriname Svalbard Svalbard and Jan Mayen (COB,PIC) Swan Islands (COB,PIC) Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Trust Territory of the Pacific Islands (COB,PIC) Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom United States (COB) United States Misc. Pacific Islands (COB,PIC) Unknown Uruguay USSR Uzbekistan Vanuatu (Nbds,nheb) Vatican City Venezuela Vietnam Virgin Islands (COB) Wake Island (COB) Wallis and Futuna West Bank Western Sahara Yeman (Sanaa) (COB,PIC) Yemen Yemen (Aden) (COB,PIC) Yugoslavia (COB,PIC) Zambia Zimbabwe
* 6. Gender
Female
Male
* 7. Relationship
spouse
daughter
son
* 8. Please, include a copy of passport photo page this dependent