USA VISA INFORMATION FORM

Interview Location : …………………………………………. English

Interview language:………………………………..

Applicant’s Details :
Ajey S Paranjape
Name of Applicant: …………………………………………………………………………………………………………….……………
28 April 1964
Date Of Birth …………………………….…………….Place Pune, Maharashtra, India
of Birth …………………………………………………………………
-
Maiden Name or Previous Name : ………………………………………………………………………………………………………
D-13 Flat no 2, Sarita Nagari Phase 2
Current Address:………………………………………………………………………………………………………………………………
Off Sinhagad road, Pune 411030
……………………………………………………………………………………………………………………………Pin…………………….…..
9890192167
Mobile No. 1) ………………………………………………………. 9822956256
2) ……………………………………………………………………
8830311757
Work Phone No. …………………………………………………… Married
Marital Status ………………………………………………..
ajeysp@yahoo.com
Email ID …………………………………………………………………………………………………………………………………………..

Passport Details :
T3313829
Passport No. ……………………………………………… Pune
Place Of Issue …………………………………………………………….
28 Mar 2019
Issue Date ……………………………………………………….. 27 Mar 2029
Valid upto……………………………………………………..………
Home Delivery
Passport Delivery : Pickup or Home Delivery : ……………...………………(Home Delivery Charges Rs. 650/- PP)
B1/B2
Type of Visa:B1 (Business) /B2 (Family visit/Tourism) / B1/B2 (Both) : ………………………………….

Have you ever lost your previous Passport :If Yes then
N/A
Passport No: ……………………………………………… Country of issued : ………………………………………………………….

Reason :…………………………………………………………………………………………………………………………………………………….
24 April 2024
Intended Travel Date :……………………………………………. 1 Month
Length Of Stay ……………………………………………………….
Vibhas Sudhakar Paranjape
Address in USA : Invitor’s full name : ………………………………………………………………………………………………………
123 Maple Street
Street address : ……………………………………………………………………………….………………………………………………..……..

Lexington
City : ………………………………………..State MA
: …………………………………………………………. 02420
Zip code : ……………………..
Vibhasp@hotmail.com
Email : ………………………………………………………………………………………………
Self
Who is paying for you : 1 ) Self 2 ) Other Person 3) Other Company …………………………………………………

If other person/company paying for you then give the Details of (Sponsor)

Full Name : …………………………………………………………………………………………………………………………………………….

Full address : …………………………………………………………………………………………………………………………………………..

Tel No : ………………………………………………….. Relation with you : ……………………………………………………………….

Email Id : …………………………………………………………………………………………………………………………………………………

Who is travelling with you :

Shubhada Ajey Paranjape
1) Full Name : …………………………………………………………………………………………………... Relation ………………

2) Full Name : …………………………………………………………………………………………………... Relation ………..……

3) Full Name : …………………………………………………………………………………………………... Relation ………………

Previous refusal for USA visa :Date of Refusal …………….…………………………. Type …………………………………….
05 Apr 23
Previous five USA travel visits : 1) ……………………………………………………… 20 days
Length of Stay : …………………………
03 Mar 22
2) …………………………………… 5 weeks
Length of Stay : …………… 09 Jun 2019
…………..3) …………………………………………Length of Stay
1.5 months 10 May 2015 10 days
: ………………………………………..4) ……………………………………………………… Length of Stay : …………………………
14 May 2009
5) ……………………………………………………… 6 weeks
Length of Stay : …………………………

USA Driving Licno : ……………………………………………………….. State of Issued IN USA:…………………………………..

14 Apr 2014
Previous USA visa issued date : ……………………………………… J2984095
Previous Visa Number : …………………………………

No
Have you ten printed previously: Yes/No : ……………………………………………

Do you have a Social Media Presence? :

Ask Fm, Douban, Facebook, Flickr, Googl+, Instagram, Linkedin, My Space, Pinterest, Qzone (Qq),
Reddit, SeinaWeibo, TencentWeibo, Tumblr, Twitter, Twoo, Vine, Ukontakte (Vk), Youku, Youtube.

Social Media Identifier :

FB: ajey.paranjape
1. ___________________________________________________________________________________

2. ___________________________________________________________________________________

3. ___________________________________________________________________________________

4. ___________________________________________________________________________________

US Contact

Sneha Paranjape
Full name of Invitee /Hotel name / Invitee company Name : ……………………………………………………………………

Full Address in USA: 807 3rd Ave N

………………………………………………………………………………………………………………………………….
Seattle WA98109
………………………………………………………………………………………………………………………………………………………………….
Sneha11Oct@gmail.com
+1 669-274-7220 Email Id :……………….…………………………………………………………….
Contact No : ………………………………………………

Applicant’s Family Details :

Sudhakar Ramkrishna Paranjape
Father Full Name:……………………………………………………………………………………………………………………………………
 10 Dec 1936 No
Father’s Date of Birth :……………………………………….. Whether he is in USA : ………………………………………...
Neela Sudhakar Paranjape
Applicant’s Mother Full Name:…………………………………………………………………………………………………………..…
05 Mar 1940 No
Mother’s Date of Birth :…………………………………………. Whether she is in USA : ………………………………..……….
Shubhada Ajey Paranjape
Applicant’s Spouse Full Name:………………………………………………………………………………….………………………….
17 Nov 1967
Mumbai
Date of Birth :………………………………………….….. Place of Birth:………………………………………………..……………….

Immediate relatives in USA

Sneha Paranjape
Full name : ………………………………………………………………………………………………………………………………………………
Daughter
Relation with you : …………………………………………………………………………….
Non-immigrant
Visa status : 1) US Citizen 2) Non-Immigrant 3) Green Card : ……………………………………………………………

Other relatives in USA : Yes/No : if Yes, then give the following details :
Vibhas Paranjape
Name :…………………………………………………………………………………………………………………………………………………….
123, Maple Street, Lexington ,MA
Address : 02420
………………………………………………………………………………………………………………………………………………..

Occupation Details :
CFA Director
Current Profession : ……………………………………………………………Designation……………………………………………….

Fidelity Investments
Company Name : …………………….……………………………………………………………………………………………………………..

Full address :……………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………….
Boston MA
City : ………………………………………….. State: ……………………………………………………… ZIP Code : ………………………

Contact no : ………………………………………………………….

Job Started from : ………………………………………………..

Monthly Salary : ……………………………………………………

Briefly Describe Duties : …………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………….

Previous Job Details (Last 5 Yrs.):

Company Name : ………………………………………………………………………………………………………………………………………

Designation : ……………………………………………………………………….

Full address : …………………………………………………………………………………………………………………………………………….

City : …………………………………….. State: ………………………………………………………. ZIP Code : …………………………..

Contact no : …………………………………… Supervisor Full Name : …………………………………………………………………

Start Date : ……………………………………………………….. End Date : …………………………………………………………………..

Briefly Describe Duties: ……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………

Higher Education Details :

Name of college/School : ………………………………………………………………………………………………………………………

Full Address: ……………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………….. Pin ………………………………..

Contact no : …………………………………………………….. Course Name : …………………………………….………………………

Course start Date : ………………………………………….. Course End Date : ………………………………………………………..

Language Known : 1) ……………………………………… 2) ……………………………………… 3) …………………….………………

4) ……………………………………….. 5) …………………………………………. 6) ……………………………………………………

Name of Countries travelled in Last 5 Years :1) ……………………………………… 2) ………………………………………

3) ……………………………………….. 4) …………………………………………. 5) ……………………………………………………

6) ……………………………………….. 7) …………………………………………. 8) ……………………………………………………

For F1& F2 Visa (Student Visa )

Additional Point of Contact other than relative (1) Additional Point of Contact other than relative (2)
Name Name

Address Address

Contact no & Mail id Contact no & Mail id

Note: Kindly attach Below Documents along with this form

1) 1st and last page of Passport copy – Applicant

2) 1st and last page of Passport and visa copy – InviteeInvitation Letter from USA
3) For F1 & F2 Student Visa attach I 20 or DS2019

Please note:
1) Visa fees are nonrefundable, even if visa is rejected.
2) We only help in assisting in preparation and submission of the visa application on behalf of the
applicant. We are not responsible for any false information given by applicant as well as the
result of visa application.
 3) Applicant needs to undergo finger printing and interview in Mumbai as well as passport
collection from the concerned office on his own.

4) I am aware that, due to the ongoing pandemic, appointment availability for Biometrics and
Interview as well as Drop box scheme is delayed where it may take more than six months for
scheduling appointments.

I accept the above terms and conditions and declare that the information given above/overleaf is true to
best of my knowledge. I will not held ESHA HOLIDAYS responsible for any outcome of the visa
application.
Place:

Date :
Signature of the Applicant: __________________________

Name of the Applicant: __________________________