美国签证表格-DS160签证表格模版

Passport/Travel Document Type:REGULAR

Passport/Travel Document Number:G1******* Passport Book Number:09548108 Country/Authority that Issued Passport/Travel Document:CHINA City Where Issued: GUANGZHOU State/Province Where Issued:GUANGDONG Country Where Issued:CHINA

Issuance Date:29MARCH2005 Expiration Date: 28MARCH2015 Have you ever lost a passport or had one stolen?NO

Travel Information

Email Address:HWANG@https://www.sodocs.net/doc/654850438.html,

Family Information

Father's Surnames:LUO

Father's Given Names:ZUIMEI

Father's Date of Birth: 16OCTOBER1962

Is your father in the U.S.?NO

Mother's Surnames:LI

Mother's Given Names:HUAJIAN

Mother's Date of Birth:15FEBRUARY1964

Is your mother in the U.S.?NO

NO

Do you have any immediate relatives,not including parents in the

U.S.?

Do you have any other relatives in the United States?NO

Spouse's Full Name:LIN,LINLIN

Spouse's Date of Birth:12APRIL1988

Spouse's Nationality:CHINA

Spouse's City of Birth:ZHUHAI

Spouse's Country of Birth:CHINA

Spouse s Address:SAME AS HOME ADDRESS

Work/Education/Training Information

Primary Occupation:BUSINESS

Present Employer or School Name:DONGSHAN DONGXIECHENG SEAFOODS CO LTD

Address:INDUSTRY AND TRADE ZONE,TONGXING VILLAGE

TONGLING TOWN,JINWAN DISTRICT City:ZHUIHAI

State/Province:GUAGNDONG

Postal Zone/Zip Code:510200

Country:CHINA

Work Phone Number:0765-********

Monthly Salary in Local Currency(if employed):10000

Briefly Describe your Duties:POSITION:PRESIDENT&COMPANY CORPORATE REPRESENTATIVE.

DUTIES:OVERALL RESPONSIBILITY FOR THE COMPANY OPERATION

AND INTERNATIONAL BUSINESS.

YES

Have you attended any educational institutions at a secondary

level or above?

Name of Institution(1):NO2DONGSHAN MIDDLE SCHOOL OF FUJIAN

Address of Institution:NO.162YANWU STREET

TONGLING TOWN,DONGSHAN COUNTY

Date of Attendance From:01AUGUST1972

Date of Attendance To:01JULY1974

Do you belong to a clan or tribe?NO

Have you traveled to any countries within the last five years?YES

Country Visited(1):KOREA,REPUBLIC OF(SOUTH)

Country Visited(2):JAPAN

Country Visited(3):VIETNAM

Country Visited(4):INDONESIA

Have you belonged to,contributed to,or worked for any professional,

NO

social,or charitable organization?

NO

Do you have any specialized skills or training,including firearms,

explosives,nuclear,biological,or chemical experience?

Have you ever served in the military?NO

NO

Have you ever served in,been a member of,or been involved with a

paramilitary unit,vigilante unit,rebel group,guerrilla group,or

insurgent organization?

Security and Background Information

Do you have a communicable disease of public health significance?(Communicable diseases of public significance include chancroid,

NO gonorrhea,granuloma inguinale,infectious leprosy,lymphogranuloma venereum,infectious stage syphilis,active tuberculosis,and

others diseases as determined by the Department of Health and Human Services.)

Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?NO Are you or have you ever been a drug abuser or addict?NO

NO Have you ever been arrested or convicted for any offense or crime,even though subject of a pardon,amnesty,or other similar

action?

Have you ever violated,or engaged in a conspiracy to violate,any law relating to controlled substances?NO

NO Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in

prostitution or procuring prostitutes within the past10years?

Have you ever been involved in,or do you seek to engage in,money laundering?NO Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?NO

NO Are you the spouse,son,or daughter of an individual who has committed or conspired to commit a human trafficking offense in the

United States or outside the United States and have you within the last five years,knowingly benefited from the trafficking activities?

NO Have you knowingly aided,abetted,assisted or colluded with an individual who has committed or conspired to commit a severe

human trafficking offense in the United States or outside the United States?

Do you seek to engage in espionage,sabotage,export control violations,or any other illegal activity while in the United States?NO Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?NO Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?NO Are you a member or representative of a terrorist organization?NO Have you ever ordered,incited,committed,assisted,or otherwise participated in genocide?NO Have you ever committed,ordered,incited,assisted,or otherwise participated in torture?NO

NO Have you committed,ordered,incited,assisted,or otherwise participated in extrajudicial killings,political killings,or other acts of

violence?

Have you ever engaged in the recruitment or the use of the child soldiers?NO

NO Have you,while serving as a government official,been responsible for or directly carried out,at any time,particularly severe

violations of religious freedom?

NO Have you ever been directly involved in the establishment or enforcement of the population controls forcing a woman to undergo an

abortion against her free choice or a man or a woman to undergo sterilization against his or her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?NO

NO Have you ever sought to obtain or assist others to obtain a visa,entry into the United States,or any other United States immigration

benefit by fraud or willful misrepresentation or other unlawful means?

Have you ever withheld custody of a U.S.citizen child outside the United States from a person granted legal custody by a U.S.court?NO Have you voted in the United States in violation of any law or regulation?NO Have you ever renounced United States citizenship for the purpose of avoiding taxation?NO

Location Information

Location where you will be submitting your application

Current Location:GUANGZHOU,CHINA

Preparer of Application

Did anyone assist you in filling out this application?YES

Preparer Surnames:HUANG

Preparer Given Names:JAACCC

Organization Name:IIC INTERNATIONAL Street Address:D19, 16F SUNCET PLAZA

NO.197 GUANGZHOU AVE.,YUEXIU DISTRICT City:GUANGZHOU

State/Province:GUANGDONG

Postal Zone/ZIP Code:510650

Country:CHINA

Relationship to You:BUSINESS AGENT

03-May-201206:52:31.

28U.S.C.1746)