入力内容保存／読込
保存したデータ読込
現在の入力内容を保存
保存データ削除
保存日：
USA B1/2 Visa information form
【アメリカ商用/観光ビザ 申請者情報記入フォーム】
◆パスポートと在留カードを用意し、ご両親の生年月日を確認してください。
◆このフォームは、SSL暗号化通信で保護されています。
◆記入した情報は、大使館へ提出しませんので、ご安心ください。
Oversea Visa Support Center
在日外国人の海外ビザ サポートセンター
東京都豊島区南大塚1－60－20
TEL
03-5981-7856
1. Please be sure to fill it out carefully and ture.
2.【必须】Can not be blank.
3. You can save and exit on the way, click this button →【入力内容保存／読込】⇒【現在の入力内容を保存】
4. If you want to continue，click this button【入力内容保存／読込】⇒【保存したデータ読込】
5.When you are finish,click this button【内容確認画面へ】
Name
必須
Surname / Frist name
姓
名
Other Name
必須
Yes
No
Sex
必須
Female
Male
Date of birth
必須
西暦
Year
01
02
03
04
05
06
07
08
09
10
11
12
Month
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
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22
23
24
25
26
27
28
29
30
31
Day
Father's Name
必須
Surname/First name
Father's date of birth
必須
西暦
Year
01
02
03
04
05
06
07
08
09
10
11
12
Month
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
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22
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25
26
27
28
29
30
31
Day
Mother's name
必須
Surname/First name
Mother's date of birth
必須
西暦
Year
01
02
03
04
05
06
07
08
09
10
11
12
Month
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Place of birth
必須
Country/City E.g:China,Fujian,Fuzhou
Nationality
必須
Do you have the following resume
必須
You can choose one or more
Illegal entry in Japan or other countries
Illegal stagnation in Japan or other countries（Including legal residence after conversion visa）
History of crimes, in Japan or other countries
I don't have the above resume
Visa status in Japan
Period of stay
西暦
Year
01
02
03
04
05
06
07
08
09
10
11
12
Month
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please confirm the Residence card
Residence card Number
Post code
必須
EG：123-4567
Current Address
必須
Please type in Japanese the same as Residence card.
Mobile number
必須
EG：08012345678
E-mail address
確認用
When did you come to Japan for the first time?
EG:2000/6/1 for tourism.2012/4/1 for study(Language school)
Marital Status
必須
You can choose one or more
Single/Never Marriage
Marriage（First time）
Marriage（Second time or more）
Divorced（Once）
Divorced（Twice or more）
Widowed
I have boy(girl)friend，we living together
I have boy(girl)friend，but don't living tohether
Did you have another relative in Japan?
必須
You can choose one or more
Parents
Spouse
Children
I didn't have any relative in Japan
Passport Number
必須
Date of Expiry
必須
西暦
Year
01
02
03
04
05
06
07
08
09
10
11
12
Month
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Date of issue
必須
西暦
Year
01
02
03
04
05
06
07
08
09
10
11
12
Month
01
02
03
04
05
06
07
08
09
10
11
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19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Place of issue
必須
EG:China,Fujian
Do you have old passport
必須
Yes
No
Where is your old passport
必須
You can choose one or more
this is the first one
I have the old one，by my side
I have the old one，in my hometown
I have the old one，lost
Have you ever been issued a U.S. visa?
必須
Yes,I used to get a U.S. visa.
No,This is my first time to sumbit.
Have you ever been refused a U.S. Visa?
必須
No
Refused once
Refused tiwce or more
When and which city do you want to visit in America
必須
Persons Traveling with You
必須
Please fill in Alphabet.
Even if they won't travel with you,we suggest you provide 1-3 passers.
Person/Entity Paying for Your Trip
必須
Self
Other person
Other organization（EG:My Company）
Do you have anyone knows in America
必須
You can choose one or more
Parents
Spouse
Boy(Girl)friend
Children
Other relative
Friends
None of the above
Current Employment
必須
Salary man（I have certificate of employment）
Director（I have Business license）
Selfemployment（I have a store and Business license）
Selfemployment(I have no Business license)
Student (University)
Student（Other than university）
Housewife
Retire
Part-time job
Nonemployment
Other
Please tell us the information of your job
必須
EG:Company name,Position,Tel of company,when did you star your work?Briefly Describe your Duties
If you are student,please tell us your school's information
必須
if you are not a student,Please fill in [I am not a student]
①School name②Department ③Coures ④Enrollment date
Final Education
必須
Doctor
Master（修士）
University
College
Highschool and below
If your Final Education is University and above,please tell us the information of the school
【1】University：①School name ②Department ③Course ④Enrollment date
【2】Master and Doctor：①School name ②Department ③Course ④Enrollment date
Have you traveled to any countries?
必須
Tell us all of them.
If you have another message want to tell us:
内容確認画面へ