USA Visitor Visa – Short Application Form

USA Visitor – Short Application Form

Fill the form below to register interest for a visitor visa. This is a simplified intake form for pre-screening purposes only — it does not replace official government visa applications.

Full name

Date of birth

Nationality

Passport number

Passport expiry date

Email address

Phone number

Purpose of visit (select and describe)

Planned arrival date

Planned departure date

Address in the USA (if known)

Current occupation

Employer / Organization (if applicable)

Have you visited the USA before?

Have you ever been refused a US visa?

Travel companions (names & relation) — if any

Do you have any criminal convictions?

Do you have any serious medical conditions we should be aware of?

Emergency contact (name, phone, relation)

Upload passport scan (photo or PDF)

Files are stored temporarily for pre-screening only. Do not send sensitive documents through unsecured channels.

Additional questions (why should your visa be approved? any special requests?)

I confirm that the information provided is accurate to the best of my knowledge. I understand this is a pre-screening form and not an official visa application.

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USA Visitor – Short Application Form

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USA Visitor – Short Application Form

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