Online Nonimmigrant Visa Application (DS-160)

Application - Sensitive But Unclassified(SBU)

We do not need a printed copy of your application at any point during your interview process. Only print this
application if you want a copy for your own records. If you print your application, please keep it secure.
Photo Provided:
Confirmation Number:
Your Personal Copy -- Do Not Bring to Interview
Personal, Address, Phone, and Passport/Travel Document Information
Name Provided: BISWAS, MOUSHUMI
Full Name in Native Language: DOES NOT APPLY
Other Names Used: NO
Telecode Name Used: NO
Sex: FEMALE
Marital Status: MARRIED
Date of Birth: 09 AUGUST 1970
Place of Birth: AGARTALA, TRIPURA, INDIA
Country/Region of Origin (Nationality): CANADA
Do you hold or have you held any nationality other than the one
indicated above on nationality?
NO
National Identification Number: 529171209
U.S. Social Security Number: 213875610
U.S. Taxpayer ID Number: DOES NOT APPLY
Home Address: 5006 MEADOW LANDING CT
APT# 404
City: SUGAR LAND
State/Province: TEXAS
Postal Zone/ZIP Code: 77479
Country/Region: UNITED STATES OF AMERICA
Same Mailing Address? YES
Primary Phone Number: 2812773904
Secondary Phone Number: 3012508009
Work Phone Number: 7132356735
Email Address: mbiswas@bechtel.com
Passport/Travel Document Type: REGULAR
Passport/Travel Document Number: WG457277
Passport Book Number: DOES NOT APPLY
Country/Authority that Issued Passport/Travel Document: CANADA
City Where Issued: GATINEAU
Country/Region Where Issued: CANADA
Issuance Date: 09 NOVEMBER 2011
Expiration Date: 09 NOVEMBER 2016
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): TEMPORARY WORKER (H)
Specify: SPECIALTY OCCUPATION (H1B)
Application Receipt/Petition Number: EAC1314050455
Intended Date of Arrival: 28 DECEMBER 2013
Intended Length of Stay in U.S.: 6 YEAR(S)
Address where you will stay in the U.S.: 5006 MEADOW LANDING CT
Person/Entity Paying for Your Trip: U.S. PETITIONER
Are there other persons traveling with you? NO
Have you ever been in the U.S.?
YES
Date Arrived (1): 29 JUNE 2009
Length of Stay: 1 YEAR(S)
Date Arrived (2): 11 JANUARY 2010
Length of Stay: 2 YEAR(S)
Date Arrived (3): 29 MAY 2012
Length of Stay: 1 YEAR(S)
Do you or did you hold a U.S. Driver's License? NO
Have you ever been issued a U.S. Visa?
YES
Date Last Visa was Issued: 29 MAY 2012
Visa Number: DO NOT KNOW
Are you applying for the same type of visa? NO
Are you applying in the same country where the visa above is issued
and is this country your principal country of residence?
YES
Have you been ten-printed? NO
Has your U.S. Visa ever been lost or stolen? NO
Has your U.S. Visa ever been cancelled or revoked? NO
Have you ever been refused a U.S. Visa, or 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.: BISWAS, PRANESH
Organization Name in the U.S.: BECHTEL CORP
Relationship to You: SPOUSE
U.S. Contact Address: 5006 MEADOW LANDING CT
SUGAR LAND, TEXAS 77479
Phone Number: 2402640373
Email Address: pranesh9000@yahoo.com
Family Information
Father's Surnames: SAHA
Father's Given Names: SISIR KUMAR
Father's Date of Birth: DO NOT KNOW
Is your father in the U.S.? NO
Mother's Surnames: SAHA
Mother's Given Names: MIRA
Mother's Date of Birth: DO NOT KNOW
Is your mother in the U.S.? NO
Do you have any immediate relatives, not including parents in the
U.S.?
YES
Relative Name (1): BISWAS, PRANESH
Relationship to you: SPOUSE
Status: NONIMMIGRANT
Spouse's Full Name: BISWAS, PRANESH
Spouse's Date of Birth: 25 FEBRUARY 1969
Spouse's Country/Region of Origin (Nationality): CANADA
Spouse's City of Birth: PANCH POTA, 24 PGS-N
Spouse's Country/Region of Birth: INDIA
Spouses Address: SAME AS HOME ADDRESS
Work/Education/Training Information
Primary Occupation: ENGINEERING
Present Employer or School Name: BECHTEL CORPORATION
Address: 3000 POST OAK BLVD
APT# 404
City: HOUSTON
State/Province: TEXAS
Postal Zone/Zip Code: 77056
Country/Region: UNITED STATES OF AMERICA
Work Phone Number: 7132356735
Monthly Salary in Local Currency (if employed): 9500
Briefly Describe your Duties: SENIOR ELECTRICAL ENGINEER. DESIGN THE
ELECTRICAL POWER EQUIPMENT FOR OIL & GAS
PROJECTS.
Were you previously employed?
YES
Employer Name (1): FLUOR CORP
Employer Address: 55 SUNPARK PLAZA SE
City: CALGARY
State/Province: ALBERTA
Postal Zone/Zip Code: T2X 3R4
Country/Region: CANADA
Telephone Number: 4035374000
Job Title: SR ELECTRICAL ENGINEER
Supervisor's Surname: NEERAJ
Supervisor's Given Name: DO NOT KNOW
Employment Date From: 15 OCTOBER 2007
Employment Date To: 28 FEBRUARY 2009
Briefly describe your duties: DESIGNING ELECTRICAL EQUIPMENT FOR OIL &
GAS PROJECTS.
Security and Background Information
Do you have a communicable disease of public health significance? (Communicable diseases of public significance
include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious
stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human
Services.)
NO
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of
yourself or others?
NO
Are you or have you ever been a drug abuser or addict? NO
Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or
other similar action?
NO
Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? NO
Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been
engaged in prostitution or procuring prostitutes within the past 10 years?
NO
Have you ever been involved in, or do you seek to engage in, money laundering? NO
Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the
United States?
NO
Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human
trafficking offense in the United States or outside the United States and have you within the last five years,
knowingly benefited from the trafficking activities?
NO
Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or conspired to
commit a severe human trafficking offense in the United States or outside the United States?
NO
Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the
United States?
NO
Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist
activities?
NO
Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist
organizations?
NO
Are you a member or representative of a terrorist organization? NO
Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? NO
Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? NO
Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings,
or other acts of violence?
NO
Have you ever engaged in the recruitment or the use of the child soldiers? NO
Have you, while serving as a government official, been responsible for or directly carried out, at any time,
particularly severe violations of religious freedom?
NO
Have you ever been directly involved in the establishment or enforcement of the population controls forcing a
woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or
her free will?
NO
Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue? NO
Have you ever been the subject of a removal or deportation hearing? NO
Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United
States immigration benefit by fraud or willful misrepresentation or other unlawful means?
NO
Have you failed to attend a hearing on removability or inadmissibility within the last five years? NO
Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or
otherwise violated the terms of a U.S. visa?
NO
Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal
custody by a U.S. court?
NO
Have you voted in the United States in violation of any law or regulation? NO
Have you ever renounced United States citizenship for the purpose of avoiding taxation? NO
Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement? NO
Have you attended a public elementary school on student (F) status or a public secondary school after November
30, 1996 without reimbursing the school?
NO
Temporary Work Visa Information
Application Receipt/Petition Number: EAC1314050455
Name of Person/Company who Filed Petition: BAL CORPORATE IMMIGRATION RONALD OYE
ATTORNEY
Where Do You Intend to Work?
Name of Employer: BECHTEL CORPORATION
Street Address: 3000 POST OAK BLVD
HOUSTON, TEXAS 77056
Phone Number: 7132356735
Monthly Income (in USD): $9,500
Location Information
Location where you will be submitting your application
Current Location: KOLKATA, INDIA
Preparer of
Application
Did anyone assist you in filling out this application? YES
Preparer Surnames: BISWAS
Preparer Given Names: PRANESH
Organization Name: DOES NOT APPLY
Street Address: 5006 MEADOW LANDING CT
City: SUGAR LAND
State/Province: TEXAS
Postal Zone/ZIP Code: 77479
Country/Region: UNITED STATES OF AMERICA
Relationship to You: SPOUSE
Your Personal Copy -- Do Not Bring to Interview
You electronically signed your application on 06-Nov-2013 12:02:39. You were required to electronically sign your application
yourself, unless otherwise exempt by regulation, even if the application was prepared by someone other than yourself. Your
electronic signature certifies that you have read and understood the questions in this application and that your answers are true
and correct to the best of your knowledge and belief. The submission of an application containing any false or misleading
statements may result in the permanent refusal of a visa or the denial of entry into the United States. All declarations made in
this application are unsworn declarations made under penalty of perjury. (28 U.S.C. 1746).
The information that you have provided in your application and other information submitted with your application may be
accessible to other government agencies having statutory or other lawful authority to use such information, including for law
enforcement and immigration law enforcement purposes. The photograph that you provide with your application may be used for
employment verification or other U.S. law purposes.