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OMB APPROVAL NO.1405-0096
EXPIRES: 07/31/2007
ESTIMATED BURDEN: 1 HOUR*
U.S. Department of State
NONIMMIGRANT FIANCÉ(E) VISA APPLICATION
USE WITH FORM DS-156
The following questions must be answered by all applicants for visas to enter the United States as the fiancée or fiancé of a U.S. citizen in order that a determination may be
made as to visa eligibility.
This form, together with Form DS-156, Nonimmigrant Visa Application, completed in duplicate, constitutes the complete application for a "K" Fiancé(e) Nonimmigrant
Visa authorized under Section 222(c) of the Immigration and Nationality Act.
1. FAMILY NAME
FIRST NAME
MIDDLE NAME
Agrawal
Manisha
2. DATE OF BIRTH (mm-dd-yyyy)
11-20-1975
Devi
3. PLACE OF BIRTH (City, Province, Country)
Mumbai, Maharashtra, India
4. MARITAL STATUS
If you are now married or were previously married, answer the following:
a. Name of spouse:
Ramesh Agrawal
b. Date (mm-dd-yyyy) and place of marriage:
c. How and when was marriage terminated:
04-23-2001
New Delhi, India
By final divorce, 06-20-2004
d. If presently married, how will you marry your U.S. citizen fiancé(e)? Explain:*
* NOTE: If presently married to anyone, you are not eligible for a fiancé(e) visa.
5. LIST NAME, DATE AND PLACE OF BIRTH OF ALL UNMARRIED CHILDREN UNDER 21 YEARS OF AGE
BIRTH PLACE
BIRTH DATE
NAME
(mm-dd-yyyy)
Jay Agrawal
05-01-2003
WILL ACCOMPANY WILL FOLLOW
YOU
YOU
YES NO
YES NO
Mumbai, India


THE FOLLOWING DOCUMENTS MUST BE ATTACHED IN ORDER TO APPLY FOR A FIANCE(E) NONIMMIGRANT VISA
Evidence of engagement to your fiancé(e)
Marriage certificate (if any)
Your birth certificate
Birth certificates of all children listed in No. 5
Divorce decree (if any)
Evidence of financial support
Death certificate of spouse (if any)
Police certificates
NOTE: All of the above documents will also be required by the U.S. Citizenship and Immigration Services (USCIS) when you apply for adjustment of status to lawful
permanent resident. The USCIS will accept these documents for that purpose.
DO NOT WRITE BELOW THIS LINE
The consular officer will assist you in answering this part.
I understand that I am required to submit my visa to the United States Immigration Officer at the place where I apply to enter the United States,
and that the possession of a visa does not entitle me to enter the United States if at that time I am found to be inadmissable under the immigration
laws. I further understand that my adjustment of status to permanent resident alien is dependent upon marriage to a U.S. citizen and upon meeting
all of the requirements of the U.S. Department of Homeland Security.
I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may subject me to
permanent exclusion from the United States and, if I am admitted to the United States, may subject me to criminal prosecution and/or deportation.
I hereby certify that I am legally free to marry and intend to marry
, a U.S. citizen, within 90
days of my admission into the United States.
I do solemnly swear or affirm that all statements which appear in this application have been made by me and are true and complete to the best
of my knowledge and belief.
Signature of Applicant
SUBSCRIBED AND SWORN TO before me this
day of
,
at:
United States Consular Officer
*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 data, providing the information
required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send
comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, D.C. 20520.
DS-156K
07-2004
PREVIOUS EDITIONS OBSOLETE