Consular Electronic Application Center Print Application

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09.04.2021

Consular Electronic Application Center - Print Application

https://ceac.state.gov/IVApp/common/printapplication.aspx?dlUpzRqBKNte94FUmviWpJS0jrL5LlAdgZI8IJT9TSE%3d

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Online Immigrant Visa and Alien Registration Application (DS-260)

Application - Sensitive But Unclassified(SBU)

Case

Number:

Confirmation

Number:

Personal, Address and Phone Information

Name Provided:

KHUJAKULOV , FAKHRIYOR

Full Name in Native Language:

DOES NOT APPLY/TECHNOLOGY NOT

AVAILABLE

Other Names Used:

NO

Sex:

MALE

Current Marital Status:

MARRIED

Date of Birth:

08 APRIL 1995

City of Birth:

SAMARKAND

State/Province of Birth:

DOES NOT APPLY

Country/Region of Birth:

UZBEKISTAN

Country/Region of Origin (Nationality):

UZBEKISTAN

Document Type:

PASSPORT

Document ID:

AB6499374

Country/Authority that Issued Document:

UZBEKISTAN

Issuance Date:

14 APRIL 2017

Expiration Date:

13 APRIL 2027

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09.04.2021

Consular Electronic Application Center - Print Application

https://ceac.state.gov/IVApp/common/printapplication.aspx?dlUpzRqBKNte94FUmviWpJS0jrL5LlAdgZI8IJT9TSE%3d

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Do you hold or have you held any nationality other than the one you

have indicated above?

NO

Present Address:

OKDARYO DISTRICT NAVOIY QFY

City:

OKDARYO DISTRICT

State/Province:

DOES NOT APPLY

Postal Zone/ZIP Code:

DOES NOT APPLY

Country/Region:

UZBEKISTAN

From Date:

MAY 1995

Have you lived anywhere other than this address since the age of

sixteen?

NO

Primary Phone Number:

[phone]

Secondary Phone Number:

DOES NOT APPLY

Work Phone Number:

DOES NOT APPLY

Other Telephone Numbers Used:

NO

Email Address:

[e-mail]

Other Email Addresses Used:

NO

Social Media Provider/Platform:

NONE

Other Social Media Used:

NO

Is your Mailing Address the same as your Present Address?

NO

Mailing Address:

BURUKLIN

City:

NEWYORK

State/Province:

DOES NOT APPLY

Postal Zone/ZIP Code:

DOES NOT APPLY

Country/Region:

UZBEKISTAN

 

Permanent Address

Name of person currently living at address:

DOES NOT APPLY

U.S. Address:

BURKLIN

NEWYORK, TEXAS 11206

Phone Number:

DOES NOT APPLY

Is this address where you want your Permanent Residence Card

(Green Card) mailed?

YES

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09.04.2021

Consular Electronic Application Center - Print Application

https://ceac.state.gov/IVApp/common/printapplication.aspx?dlUpzRqBKNte94FUmviWpJS0jrL5LlAdgZI8IJT9TSE%3d

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