U.S. Department of State
APPLICATION FOR IMMIGRANT VISA AND
ALIEN REGISTRATION
OMB APPROVAL NO. 1405-0015
EXPIRES: 02/29/2012
ESTIMATED BURDEN: 1 HOUR*
(See Page 2)
PART I - BIOGRAPHIC DATA
Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.
Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States.
This form (DS-230 Part I) is the first of two parts. This part, together with Form DS-230 Part II, constitutes the complete Application for
Immigrant Visa and Alien Registration.
1. Family Name First Name Middle Name
2. Other Names Used or Aliases (If married woman, give maiden name)
3. Full Name in Native Alphabet (If Roman letters not used)
4. Date of Birth (mm-dd-yyyy) 5. Age 6. Place of Birth (City or Town) (Province) (Country)
7. Nationality (If dual national, give both.) 8. Gender
Female
Male 9. Marital Status
Single (Never Married) Married Widowed Divorced Separated
Including my present marriage, I have been married times.
10. Permanent address in the United States where you intend to live, if known (street address including ZIP code). Include the name of a person who currently lives there.
Telephone number 11. Address in the United States where you want your Permanent Resident Card (Green Card) mailed, if different from address in item #10 (include the name of a person who currently lives there).
Telephone number
12. Present Occupation 13. Present Address (Street Address) (City or Town) (Province) (Country)
Telephone Number (Home) Telephone Number (Office) Email Address
14. Spouse's Maiden or Family Name First Name Middle Name
15. Date (mm-dd-yyyy) and Place of Birth of Spouse
16. Address of Spouse (If different from your own) 17. Spouse's Occupation
18. Date of Marriage (mm-dd-yyyy)
19. Father's Family Name First Name Middle Name
20. Father's Date of Birth
(mm-dd-yyyy) 21. Place of Birth 22. Current Address 23. If Deceased, Give
Year of Death
24. Mother's Family Name at Birth First Name Middle Name
25. Mother's Date of Birth
(mm-dd-yyyy) 26. Place of Birth 27. Current Address 28. If Deceased, Give
Year of Death
DS-230 Part I
05-2009
This Form May be Obtained Free at Consular Offices of the United States of America
Previous Editions Obsolete
Page 1 of 4
29. List Names, Dates and Places of Birth, and Addresses of ALL Children.
Name
Date (mm-dd-yyyy)
Place of Birth
Address (If different from your own)
30. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality.
Begin with your present residence.
City or Town Province Country From/To (mm-yyyy) or "Present"
31a. Person(s) named in 14 and 29 who will accompany you to the United States now.
31b. Person(s) named in 14 and 29 who will follow you to the United States at a later date.
32. List below all employment for the last ten years.
Employer Location Job Title
From/To (mm-yyyy) or "Present"
In what occupation do you intend to work in the United States?
33. List below all educational institutions attended.
School and Location From/To (mm-yyyy) Course of Study Degree or Diploma
Languages spoken or read
Professional associations to which you belong
34. Previous Military Service
Yes No
Branch Dates of Service (mm-dd-yyyy)
Rank/Position Military Speciality/Occupation
35. List dates of all previous visits to or residence in the United States. (If never, write "never") Give type of visa status, if known.
Give DHS "A" number if any.
From/To (mm-yyyy)
Location
Type of Visa "A" Number (If known)
Signature of Applicant Date (mm-dd-yyyy)
Privacy Act and Paperwork Reduction Act Statements
The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of State uses the facts you provide
on this form primarily to determine your classification and eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide all the requested
information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department
of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social Security Administration will use the information to issue you a social security number and card.
*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202
DS-230 Part I
APPLICATION FOR IMMIGRANT VISA AND
ALIEN REGISTRATION
OMB APPROVAL NO. 1405-0015
EXPIRES: 02/29/2012
ESTIMATED BURDEN: 1 HOUR*
(See Page 2)
PART I - BIOGRAPHIC DATA
Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.
Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States.
This form (DS-230 Part I) is the first of two parts. This part, together with Form DS-230 Part II, constitutes the complete Application for
Immigrant Visa and Alien Registration.
1. Family Name First Name Middle Name
2. Other Names Used or Aliases (If married woman, give maiden name)
3. Full Name in Native Alphabet (If Roman letters not used)
4. Date of Birth (mm-dd-yyyy) 5. Age 6. Place of Birth (City or Town) (Province) (Country)
7. Nationality (If dual national, give both.) 8. Gender
Female
Male 9. Marital Status
Single (Never Married) Married Widowed Divorced Separated
Including my present marriage, I have been married times.
10. Permanent address in the United States where you intend to live, if known (street address including ZIP code). Include the name of a person who currently lives there.
Telephone number 11. Address in the United States where you want your Permanent Resident Card (Green Card) mailed, if different from address in item #10 (include the name of a person who currently lives there).
Telephone number
12. Present Occupation 13. Present Address (Street Address) (City or Town) (Province) (Country)
Telephone Number (Home) Telephone Number (Office) Email Address
14. Spouse's Maiden or Family Name First Name Middle Name
15. Date (mm-dd-yyyy) and Place of Birth of Spouse
16. Address of Spouse (If different from your own) 17. Spouse's Occupation
18. Date of Marriage (mm-dd-yyyy)
19. Father's Family Name First Name Middle Name
20. Father's Date of Birth
(mm-dd-yyyy) 21. Place of Birth 22. Current Address 23. If Deceased, Give
Year of Death
24. Mother's Family Name at Birth First Name Middle Name
25. Mother's Date of Birth
(mm-dd-yyyy) 26. Place of Birth 27. Current Address 28. If Deceased, Give
Year of Death
DS-230 Part I
05-2009
This Form May be Obtained Free at Consular Offices of the United States of America
Previous Editions Obsolete
Page 1 of 4
29. List Names, Dates and Places of Birth, and Addresses of ALL Children.
Name
Date (mm-dd-yyyy)
Place of Birth
Address (If different from your own)
30. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality.
Begin with your present residence.
City or Town Province Country From/To (mm-yyyy) or "Present"
31a. Person(s) named in 14 and 29 who will accompany you to the United States now.
31b. Person(s) named in 14 and 29 who will follow you to the United States at a later date.
32. List below all employment for the last ten years.
Employer Location Job Title
From/To (mm-yyyy) or "Present"
In what occupation do you intend to work in the United States?
33. List below all educational institutions attended.
School and Location From/To (mm-yyyy) Course of Study Degree or Diploma
Languages spoken or read
Professional associations to which you belong
34. Previous Military Service
Yes No
Branch Dates of Service (mm-dd-yyyy)
Rank/Position Military Speciality/Occupation
35. List dates of all previous visits to or residence in the United States. (If never, write "never") Give type of visa status, if known.
Give DHS "A" number if any.
From/To (mm-yyyy)
Location
Type of Visa "A" Number (If known)
Signature of Applicant Date (mm-dd-yyyy)
Privacy Act and Paperwork Reduction Act Statements
The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of State uses the facts you provide
on this form primarily to determine your classification and eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide all the requested
information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department
of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social Security Administration will use the information to issue you a social security number and card.
*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202
DS-230 Part I