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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: DAWOUD, RIAD

Full Name in Native Language: RIYADH MIFTAH ABOULQASSIM

Other Names Used: NO

Telecode Name Used: NO

Sex: MALE

Marital Status: MARRIED

Date of Birth: 25 NOVEMBER 1984

Place of Birth: AL BAYADA', LIBYA, LIBYA

Country/Region of Origin (Nationality): LIBYA

Do you hold or have you held any nationality other than the one NO
indicated above on nationality?

Are you a permanent resident of a country/region other than your NO

country/region of origin (nationality) above?

National Identification Number: DOES NOT APPLY

U.S. Social Security Number: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: NEW AL BAYADA'

NEW AL BAYADA'

City: AL BAYADA'

State/Province: LIBYA

Postal Zone/ZIP Code: 218

Country/Region: LIBYA

Same Mailing Address? YES

Primary Phone Number: 00218927822916

Secondary Phone Number: DOES NOT APPLY

Work Phone Number: DOES NOT APPLY

Email Address: [email protected]

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: LLJY6GF8

Passport Book Number: LLJY6GF8

Country/Authority that Issued Passport/Travel Document: LIBYA

City Where Issued: AL BAYADA'

Country/Region Where Issued: LIBYA

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Issuance Date: 04 MAY 2015

Expiration Date: 03 MAY 2023

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): OTHER (N)

Specify: PARENT OF CERTAIN SPECIAL IMMIGRANT (N8)

Have you made specific travel plans? NO

Intended Date of Arrival: 01 JANUARY 2018

Intended Length of Stay in U.S.: 10 YEAR(S)

Address where you will stay in the U.S.: MBMB

Person/Entity Paying for Your Trip: SELF

Are there other persons traveling with you? YES

Are you traveling as part of a group or organization? NO

Persons Traveling with You:

Name (1): DAWOUD, DOAA

Relationship to You: CHILD

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, or been refused admission to NO
the United States, or withdrawn your application for admission at the
port of entry?

Has anyone ever filed an immigrant petition on your behalf with the NO
United States Citizenship and Immigration Services?

U.S. Contact Information

Contact Person Name in the U.S.: ABDALKAREEM, RABE

Organization Name in the U.S.: DO NOT KNOW

Relationship to You: OTHER

U.S. Contact Address: GDFG

MOODY, ALABAMA 35004

Phone Number: 514519085

Email Address: [email protected]

Family Information
Father's Surnames: DAWOUD

Father's Given Names: MIFTAH ABOULGASEEM ABDALKAREEM

Father's Date of Birth: 01 JANUARY 1959

Is your father in the U.S.? NO

Mother's Surnames: YAHYA

Mother's Given Names: HAWA KHALIFA MOHAMMED YAHYA

Mother's Date of Birth: 01 JANUARY 1963

Is your mother in the U.S.? NO

Do you have any immediate relatives, not including parents in the NO

U.S.?

Do you have any other relatives in the United States? NO

Spouse's Full Name: ABDALSAMEEA, NISREEN ADIM TAHIR

Spouse's Date of Birth: 07 APRIL 1989

Spouse's Country/Region of Origin (Nationality): LIBYA

Spouse's City of Birth: AL BAYADA'

Spouse's Country/Region of Birth: LIBYA

Spouses Address: SAME AS HOME ADDRESS

Work/Education/Training Information
Primary Occupation: ENGINEERING

Present Employer or School Name: GLOBAL ELECTRIC COMPANY

Address: EL SAWANI ROAD - NEAR THE GYPSUM GATE

City: TRIPOLI

State/Province: DOES NOT APPLY

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Postal Zone/Zip Code: DOES NOT APPLY

Country/Region: LIBYA

Work Phone Number: 002182148009

Monthly Salary in Local Currency (if employed): 1250

Briefly Describe your Duties: PLANNING ENGINEER

Were you previously employed? YES

Employer Name (1): PLANNING ENGINEER

Employer Address: AL
BAYADA'

City: AL BAYADA'

State/Province: AL BAYADA'

Postal Zone/Zip Code: DOES NOT APPLY

Country/Region: LIBYA

Telephone Number: 00218214800956

Job Title: PLANNING ENGINEER

Supervisor's Surname: GECOL

Supervisor's Given Name: GECOL PLANNING ENGINEER

Employment Date From: 01 MAY 2011

Employment Date To: 14 AUGUST 2017

Briefly describe your duties: PLANNING ENGINEER

Have you attended any educational institutions at a secondary level or YES

above?

Name of Institution (1): UNIVERSITY OF OMAR MUKHTAR

Address of Institution: AL BAYADA'

City: AL BAYADA'

State/Province: AL BAYADA'

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: LIBYA

Course of Study: YEAR

Date of Attendance From: 01 SEPTEMBER 2003

Date of Attendance To: 01 JULY 2007

Do you belong to a clan or tribe? YES

Clan or Tribe Name: ALALWANI

Provide a List of Languages You Speak:

Language Name (1): ARABIC AND ENGLISH

Have you traveled to any countries/regions within the last five years? YES

Provide a List of Countries/Regions Visited

Country/Region (1): EGYPT

Country/Region (2): TUNISIA

Have you belonged to, contributed to, or worked for any professional, NO
social, or charitable organization?

Do you have any specialized skills or training, such as firearms, NO

explosives, nuclear, biological, or chemical experience?

Have you ever served in the military? NO

Have you ever served in, been a member of, or been involved with a NO
paramilitary unit, vigilante unit, rebel group, guerrilla group, or
insurgent organization?

Security and Background Information

Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, NO
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.)

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 NO
action?

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 NO
prostitution or procuring prostitutes within the past 10 years?

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

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Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the NO
United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?

Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or conspired to commit a severe NO
human trafficking offense in the United States or outside the United States?

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 NO
violence?

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 NO
violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a woman to undergo an NO
abortion against her free choice or a man or a woman to undergo sterilization against his or her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue? 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 NO
benefit by fraud or willful misrepresentation or other unlawful means?

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

Location Information
Location where you will be submitting your application

Current Location: TRIPOLI, LIBYA

Preparer of Application
Did anyone assist you in filling out this application? NO

Your Personal Copy -- Do Not Bring to Interview

You electronically signed your application on 15-Aug-2017 01:45:48 (GMT-05:00). 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).

You certified that you understand that you are required to submit your visa to the United States Immigration Officer at the port where you apply to enter
the United States, and that possession of the visa does not entitle you to enter the United States if, upon your arrival, you are found to be inadmissible
under U.S. immigration laws. You certified that you understand that any willfully false or misleading statement or willful concealment of a material fact
made by you within the application may subject you to permanent exclusion from the United States and, if you are admitted to the United States, may
subject you to criminal prosecution and/or deportation.

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. If
fingerprints are collected as part of your application process, they may be used for the purpose of comparing them to other fingerprints in the FBIs Next
Generation Identification (NGI) fingerprint system or its successor systems (including civil, criminal, and latent fingerprint repositories). The photograph
that you provide with your application may be used for employment verification or other U.S. law purposes.

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