面簽領(lǐng)館北京上海沈陽成都廣州

1、面簽領(lǐng)館：北京 上海 沈陽 成都 廣州 請您仔細閱讀此提醒：表格內(nèi)容不能有空項，如遇到?jīng)]有的情況請?zhí)顚憽盁o”或?qū)懨鳛楹尾惶顚懺颉７駝t則視為不合格申請表，并打回重新提供。此會耽誤您的處理與預約面談時間，請您重視并將表格填寫完整。中青旅簽證受理表（面試）淘寶ID(遨游可不填)訂單號請您填寫此次與您一同辦理簽證所有辦理人信息，此受理表提供一份即可，如行數(shù)不夠請自行添加辦理人姓名護照號身份證號聯(lián)系方式辦理數(shù)量目的地旅游城市出行時間年月日請您選擇未來兩個月內(nèi)，您不能面試的時間代傳遞統(tǒng)無需填寫領(lǐng)取方式（請選）使館直接寄送(面試后3-5工作日) 【請您將郵寄地址寫全】中信銀行自取(面試后5-7工作日)【例

2、：XX支行-XX區(qū)-具體地址】我方代取配送（需增加50元代取費用和支付快遞費用，面試后9-11工作日）自取中信銀行地址/使館直接郵寄地址代傳遞統(tǒng)一為我司代取無需填寫辦理人郵箱（必填）如您購買的是拒簽全退套餐，請您務必確認是否符合以下內(nèi)容（請確認）如未確認，則視為不符合拒簽全退條件。無美國拒簽記錄 五年內(nèi)有英國或申根或加拿大或美國出入境記錄（如有請隨同資料提供相應的簽證頁）提供真實的送簽資料已購買拒簽全退套餐目前處于非孕期的申請美國簽證沒有不良出境記錄（例如，境外逾期停留或沒有其他國家身份的子女） 美國簽證申請DS160信息表（請如實、詳盡填寫以下信息，如不符合本人情況，請?zhí)睢盁o”，勾選信息可注

3、顏色或用標示；請?zhí)峁┯⑽闹x謝）Personal, Address, Phone, and Passport/Travel Document InformationName Provided:Full Name in Native Language:Other Names Used:Telecode Name Used:Telecode NameSex:Marital Status:Date of Birth:Place of Birth:Country/Region of Origin (Nationality):Do you hold or have you held any nationa

4、lity other than the one indicated above on nationality?yes/noAre you a permanent resident of a country/region other than your country/region of origin (nationality) above?yes/noNational Identification Number:U.S. Social Security Number:U.S. Taxpayer ID Number:Home Address:City:State/Province:Postal

5、Zone/ZIP Code:Country/Region:Same Mailing Address?yes/noPrimary Phone Number:Secondary Phone Number:Work Phone Number:Email Address:Passport/Travel Document Type:Passport/Travel Document Number:Passport Book Number:Country/Authority that Issued Passport/Travel Document:City Where Issued:State/Provin

6、ce Where Issued:Country/Region Where Issued:Issuance Date:Expiration Date:Have you ever lost a passport or had one stolen?if yes,passport number : reason:yes/noTravel InformationThe List of Purposes of Trip to the U.S.Purpose of Trip to the U.S. (1):Specify:Have you made specific travel plans?yes/no

7、Intended Date of Arrival:Intended Length of Stay in U.S.:Address where you will stay in the U.S.:Person/Entity Paying for Your Trip:Are there other persons traveling with you?yes/noAre you traveling as part of a group or organization?yes/noPersons Traveling with You:Name (1):Relationship to You:Have

8、 you ever been in the U.S.? yes/noDate Arrived (1): Length of Stay: Date Arrived (2):Length of Stay: Do you or did you hold a U.S. Driver's License? If yes，number：yes/noHave you ever been issued a U.S. Visa? yes/noDate Last Visa was Issued: Visa Number: Are you applying for the same type of visa

9、? yes/noAre you applying in the same country where the visa above is issued and is this country your principal country of residence?yes/noHave you been tenprinted?yes/noHas your U.S. Visa ever been lost or stolen?yes/noHas your U.S. Visa ever been cancelled or revoked? yes/noYour Personal Copy Do No

10、t Bring to Interview Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?yes/noHas anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services?y

11、es/noHave you ever been in the U.S.?yes/noHave you ever been issued a U.S. visa?yes/noHave you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?yes/noHas anyone ever filed an immigrant petition on your beh

12、alf with the United States Citizenship and Immigration Services?yes/noU.S. Contact InformationContact Person Name in the U.S.:Organization Name in the U.S.:Relationship to You:U.S. Contact Address:Phone Number:Email Address:Family InformationFather's Surnames:Father's Given Names:Father'

13、s Date of Birth:Is your father in the U.S.?yes/noMother's Surnames:Mother's Given Names:Mother's Date of Birth:Is your mother in the U.S.?yes/noDo you have any immediate relatives, not including parents in the U.S.?if yes, name: relationship: status: nonimmigrant /permanent/other/US citi

14、zenyes/noDo you have any other relatives in the United States?yes/noSpouse's Full Name:Spouse's Date of Birth:Spouse's Country/Region of Origin (Nationality):Spouse's City of Birth:Spouse's Country/Region of Birth:Spouses Address:marriage date(D/M/Y)divorce date(D/M/Y)divorce rea

15、son:Work/Education/Training InformationPrimary Occupation:Present Employer or School Name:Address:City:State/Province:Postal Zone/Zip Code:Country/Region:Work Phone Number:Monthly Salary in Local Currency (if employed):Briefly Describe your Duties:Were you previously employed?yes/noEmployer Name (1)

16、:City:State/Province:Postal Zone/Zip Code:Country/Region:Telephone Number:Job Title:Supervisor's Surname:Supervisor's Given Name:Employment Date From:Employment Date To:Briefly describe your duties:Have you attended any educational institutions at a secondary level or above?yes/noName of Ins

17、titution (1):Address of Institution:City:State/Province:Postal Zone/ZIP Code:Country/Region:Course of Study:Date of Attendance From:Date of Attendance To:Do you belong to a clan or tribe?yes/noProvide a List of Languages You Speak:Language Name (1):Have you traveled to any countries/regions within t

18、he last five years?yes/noHave you belonged to, contributed to, or worked for any professional, social, or charitable organization?yes/noDo you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?yes/noHave you ever served in the military

19、? (1.service time:from D/M/Y to D/M/Y 2.military rank: 3. speciality )yes/noHave you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization?yes/noSecurity and Background InformationDo you have a communicabl

20、e disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Hu

21、man Services.)yes/noDo 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?yes/noAre you or have you ever been a drug abuser or addict?yes/noHave you ever been arrested or convicted for any offense or crime, even though subje

22、ct of a pardon, amnesty, or other similar action?yes/noHave you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?yes/noAre you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution

23、 or procuring prostitutes within the past 10 years?yes/noHave you ever been involved in, or do you seek to engage in, money laundering?yes/noHave you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?yes/noAre you the spouse, son, or

24、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?yes/noHave you knowingly aided, abetted, assisted or colluded

25、with an individual who has committed or conspired to commit a severe human trafficking offense in the United States or outside the United States?yes/noDo you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?yes/noDo you seek t

26、o engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?yes/noHave you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?yes/noAre you a member or representative of a terrorist organiza

27、tion?yes/noHave you ever ordered, incited, committed, assisted, or otherwise participated in genocide?yes/noHave you ever committed, ordered, incited, assisted, or otherwise participated in torture?yes/noHave you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killi

28、ngs, political killings, or other acts of violence?yes/noHave you ever engaged in the recruitment or the use of the child soldiers?yes/noHave you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?yes/noHave 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 woma