Consular Electronic Application Center Print Application



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Consular Electronic Application Center - Print Application

Family Information

Father's Surnames:

MARDIYEV

Father's Given Names:

YORIQUL

Date of Birth:

03 JANUARY 1967

City of Birth:

OQDARYO

State/Province of Birth:

DO NOT KNOW

Country/Region of Birth:

UZBEKISTAN

Is your father still living?

YES

Current Address:



DO NOT KNOW

Mother's Surnames at Birth:

ASHUROVA

Mother's Given Names:

SAODAT

Date of Birth:



13 OCTOBER 1972

City of Birth:

OQDARYO

State/Province of Birth:

DO NOT KNOW

Country/Region of Birth:

UZBEKISTAN

Is your mother still living?

YES

Is your mother's address the same as your father's?



YES

Spouse's Full Name:

URISHOVA, MALOKHAT

Spouse's Date of Birth:

20 SEPTEMBER 1999

Spouse's City of Birth:

JIZZAKH CITI

Spouse's State/Province of Birth:

DOES NOT APPLY

Spouse's Country/Region of Birth:

UZBEKISTAN

Spouse's Address:

SAME AS PRESENT ADDRESS

Occupation:

HOMEMAKER

Date of Marriage:

05 MARCH 2021

Marriage City:

SAMARKAND CITI

Marriage State/Province:

DOES NOT APPLY

Marriage Country/Region:

UZBEKISTAN

Is your spouse immigrating to the U.S.with you?

YES



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 have any Previous Spouses?

NO

Do you have any children?



NO

Previous U.S. Travel Information

Have you ever been in the U.S.?

NO

Have you ever been 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the United States, or withdrawn your application for admission at the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


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