Sociedad

Online Nonimmigrant Visa Application (DS-160)

Application - Sensitive But Unclassified(SBU) |
Only print this application for your records. You will not be permitted to submit a printed copy of your application during your interview process. |

Photo Provided: | |
Confirmation Number: | |
Personal, Address, Phone, and Passport/Travel Document Information |
Name Provided: |AMAYA BENITES, ADA ELISA |
Full Name in Native Language: | ADA ELISA AMAYA BENITES |
Other Names Used: | NO |
| | |
Telecode Name Used: | NO |
Sex: | FEMALE |
Marital Status: | OTHER |
| Explain: | FREE UNION |
Date of Birth: | 07 JULY 1981 |
Place of Birth: | SAN PEDRO SULA, SAN PEDRO SULA, HONDURAS |
Nationality: | HONDURAS |
Other Nationalities: | NO |
| | |National Identification Number: | 0501198102245 |
U.S. Social Security Number: | DOES NOT APPLY |
U.S. Taxpayer ID Number: | DOES NOT APPLY |

Home Address: | COL.BUENOS AIRES 12CALLE 5VE CASA 413 |
| City: | SAN PEDRO SULA |
| State/Province: | SAN PEDRO SULA |
| Postal Zone/ZIP Code: | 504 |
| Country: | HONDURAS |
Same Mailing Address? | YES |
Primary Phone Number: |97396717 |
Secondary Phone Number: | 25510169 |
Work Phone Number: | 25669174 |
Email Address: | ada_amaya13@hotmail.com |
Passport/Travel Document Type: | REGULAR |
Passport/Travel Document Number: | C735390 |
Passport Book Number: | C735390 |
Country/Authority that Issued Passport/Travel Document: | HONDURAS |
| City Where Issued: | SAN PEDRO SULA |
| State/Province WhereIssued: | SAN PEDRO SULA |
| Country Where Issued: | HONDURAS |
| Issuance Date: | 19 JULY 2010 |
| Expiration Date: | 20 JULY 2015 |
Have you ever lost a passport or had one stolen? | NO |

|
Travel Information |
The List of Purposes of Trip to the U.S. |
| Purpose of Trip to the U.S. (1): | TEMP. BUSINESS PLEASURE VISITOR (B) |
| Specify: | TOURISM/MEDICAL TREATMENT (B2) |Intended Date of Arrival: | 08 JULY 2012 |
Intended Length of Stay in U.S.: | 5 DAY(S) |
Address where you will stay in the U.S.: | 14531 BRINTON COVE RD HOUSTON.TX 77084 |
| City, State, Postal/Zip Code: | HOUSTON, TEXAS 14531 |
Person/Entity Paying for Your Trip: | SELF |

Are there other persons traveling with you? | NO |

Have you ever been in the U.S.? | NO |
Have you everbeen issued a U.S. visa? | NO |
Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry? | NO |
Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services? | NO |

U.S. Contact Information |
Contact Person Name in the U.S.: | CARAWAY,INGRID LORENA |
Organization Name in the U.S.: | DO NOT KNOW |
Relationship to You: | RELATIVE |
U.S. Contact Address: | 14531 BRINTON COVE RD HOUSTON TX 77084 |
| HOUSTON, TEXAS 77084 |
| Phone Number: | (832)692-9017 |
| Email Address: | DOES NOT APPLY |

Family Information |
Father's Surnames: | AMAYA |
Father's Given Names: | NOE |
Father's Date of Birth: | 29 JUNE1945 |
Is your father in the U.S.? | NO |
Mother's Surnames: | BENITES |
Mother's Given Names: | REINA |
Mother's Date of Birth: | 06 JANUARY 1955 |
Is your mother in the U.S.? | NO |
Do you have any immediate relatives, not including parents in the U.S.? | NO |
Do you have any other relatives in the United States? | YES |

Work/Education/Training Information |
Primary Occupation:| OTHER |
| Specify Other: | SALES JOB AND STUDY ATED UNIVERSITY LIC. MATKETING |
Present Employer or School Name: | QUIMICAS MACDEL |
Address: | COL. BUENOS AIRES 14 CALLE 4 AVE. |
| City: | SAN PEDRO SULA |
| State/Province: | CORTES |
| Postal Zone/Zip Code: | 504 |
| Country: | HONDURAS |
Work Phone Number: | 25669174 |
Monthly Salary in Local Currency (if employed):...