Fiance/Spouse Visa Questionnaire

INFORMATION ABOUT YOU (US CITIZEN)

Name

First

Middle

Last

Other Names Used 1

First

Middle

Last

Other Names Used 2

First

Middle

Last

Address History for the Past 5 Years

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Date From

Date To

Prior Address 1

Address Line 1

Address Line 2

City

State

Zip Code

Date From

Date To

Prior Address 2

Address Line 1

Address Line 2

City

State

Zip Code

Date From

Date To

Email

Phone

Prior Address 3

Address Line 1

Address Line 2

City

State

Zip Code

Date From

Date To

Phone

Email

Date of Birth

Place of Birth (City / State / Country)

Sex

Marital Status

Social Security Number (SSN)

Alien Number (USCIS Number or A#)

Information About Your Parents

Father's Name

First

Middle

Last

Date of Birth

Country of Birth

Place of Residence (City / State / Country)

Mother's Name

First

Middle

Last

Date of Birth

Country of Birth

Place of Residence (City / State / Country)

Employment History for the Past 5 Years

Name of Employer

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Employment Start Date

Employment End Date

Prior Employer Name 1

Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Employment Start Date

Employment End Date

Prior Employer Name 2

Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Employment Start Date

Employment End Date

Name of Previous Spouse 1

First

Middle

Last

Date Marriage Ended

Date

Time

Name of Previous Spouse 2

First

Middle

Last

Date Marriage Ended

Name of Previous Spouse 3

First

Middle

Last

Date Marriage Ended

You Obtained Citizenship By

Birth in the United States
Naturalization
US Citizen Parents

Have you ever filed for this or any other fiance or spouse before?

If Yes, we need copies of prior petitions filed and receipts and approval or denial notices issued.

Do you have any children under 18 years of age?

Provide Your Children's Dates of Birth

List all US States and Foreign Countries in Which You Have Resided Since Your 18th Birthday

Have You Ever Been Subject to a Temporary or Permanent Protection or Restraining Order?

Check the Box of Any Crime of Which You Have Been Arrested or Convicted

Domestic violence, sexual assault, child abuse, child neglect, dating violence, elder abuse, stalking or an attempt to commit any of these crimes
Homicide, murder, manslaughter, rape, abusive sexual contact, sexual exploitation, incest, torture, trafficking, peonage, holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or an attempt to commit any of these crimes
Three or more arrests or convictions, not for a

You must provide us with copies of all arrest reports and court documents.

Ethnicity

Race (Select All That Apply)

Height (Feet - Inches)

Weight in Pounds

Eye Color

Hair Color

INFORMATION ABOUT YOUR FIANCE/SPOUSE

Name

First

Middle

Last

Other Names Used 1

First

Middle

Last

Other Names Used 2

First

Middle

Last

Address History for the Past 5 Years

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

Prior Address 1

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

Prior Address 2

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

Prior Address 3

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date From

Date To

Email

Phone

Alien Number (USCIS Number or A#)

Social Security Number (SSN)

Date of Birth

Sex

Marital Status

Place of Birth (City / State / Country)

Country of Citienship or Nationality

Information About Your Parents

Father's Name

First

Middle

Last

Date of Birth

Country of Birth

Place of Residence (City / State / Country)

Mother's Name

First

Middle

Last

Date of Birth

Country of Birth

Place of Residence (City / State / Country)

Employment History for the Past 5 Years

Name of Employer

Employer Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Employment Start Date

Employment End Date

Name of Prior Employer 1

Employer Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Employment Start Date

Employment End Date

Name of Prior Employer 2

Employer Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Employment Start Date

Employment End Date

Name of Prior Employer 3

Employer Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Job Title

Employment Start Date

Employment End Date

Name of Previous Spouse 1

First

Middle

Last

Date Marriage Ended

Name of Previous Spouse 2

First

Middle

Last

Date Marriage Ended

Name of Previous Spouse 3

First

Middle

Last

Date Marriage Ended

Has your fiance/spouse ever been to the US?

If Yes, we need copies of his or her passport used to enter along with the I94 issued, copies of all visas and all entry stamps, and current passport.

List the Foreign National's Children

Child's Name 1

First

Middle

Last

Date of Birth

Does Child 1 Reside with the Foreign National?

Address Where Child Lives

Address Line 1

Address Line 2

City

State

Zip Code

Child's Name 2

First

Middle

Last

Date of Birth

Does Child 2 Reside with the Foreign National?

Address Where Child Lives

Address Line 1

Address Line 2

City

State

Zip Code

Child's Name 3

First

Middle

Last

Date of Birth

Does Child 3 Reside with the Foreign National?

Address Where Child Lives

Address Line 1

Address Line 2

City

State

Zip Code

Are you related to your Fiance/Spouse?

Describe the relationship here (Spouse / Cousin / Other)

Date of Your Last In-Person Meeting with Each Other

If You Have Not Met, Explain Why Below

Did You Meet Through an International Marriage Broker (IMB)?

Name of IMB

IMB Website / URL

Location of US Embassy (City and Country) Where You Wish to Apply for the Visa

Enter the Information of the Person Submitting This Questionnaire

Name *

Email *

Fiance/Spouse Visa Questionnaire

For a Fiance or Spouse of a US Citizen

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