:

AA007QNM86
Confirmation Number:
Your Personal Copy -- Do Not Bring to Interview
Personal, Address, Phone, and Passport/Travel Document Information
Name Provided: GONDRE BONILLA, ROBINSON
Full Name in Native Language: ROBINSON GONDRE BONILLA
Other Names Used: NO
Telecode Name Used: NO
Sex: MALE
Marital Status: SINGLE
Date of Birth: 20 SEPTEMBER 1971
GASPAR HERNANDEZ, PROVINCIA,
Place of Birth:
DOMINICAN REPUBLIC
Country/Region of Origin (Nationality): DOMINICAN REPUBLIC
Do you hold or have you held any
nationality other than the one indicated NO
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: 06100065348
U.S. Social Security Number: DOES NOT APPLY
U.S. Taxpayer ID Number: DOES NOT APPLY
Home Address: VERAGUA 1330
City: GASPAR HERNANDEZ
State/Province: ESPAILLAT
Postal Zone/ZIP Code: 56000
Country/Region: DOMINICAN REPUBLIC
Same Mailing Address? YES
Primary Phone Number: 8097390838
Secondary Phone Number: 8493518745
Work Phone Number: DOES NOT APPLY
Email Address: [email protected]
Passport/Travel Document Type: REGULAR
Passport/Travel Document Number: RD5049293
Passport Book Number: DOES NOT APPLY
Country/Authority that Issued
DOMINICAN REPUBLIC
Passport/Travel Document:
City Where Issued: PUERTO PLATA
State/Province Where Issued: PUERTO PLATA
Country/Region Where Issued: DOMINICAN REPUBLIC
Issuance Date: 07 MARCH 2018
Expiration Date: 07 MARCH 2024
Have you ever lost a passport or had one
NO
stolen?

Travel Information
The List of Purposes of Trip to the U.S.
TEMP. BUSINESS PLEASURE
Purpose of Trip to the U.S. (1):
VISITOR (B)
BUSINESS & TOURISM
Specify:
(TEMPORARY VISITOR) (B1/B2)
Have you made specific travel plans? NO
Intended Date of Arrival: 15 APRIL 2018
Intended Length of Stay in U.S.: 30 DAY(S)
Address where you will stay in the U.S.: 3326 APT A5
Person/Entity Paying for Your Trip: OTHER PERSON
BONILLA DE GONDRE , YLDA
Person Paying for Your Trip:
MERCEDES
Telephone Number: 8483518745
Email Address: DOES NOT APPLY
Relationship to You: PARENT
Is the address of the party paying for your
trip the same as your Home or Mailing YES
Address?
Are there other persons traveling with you? YES
Are you traveling as part of a group or
NO
organization?
Persons Traveling with You:
BONILLA DE GONDRE, YLDA
Name (1):
MERCEDES
Relationship to You: PARENT
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 the United States,
NO
or withdrawn your application for admission
at the port of entry?
Has anyone ever filed an immigrant petition
YES
on your behalf with the United States
Citizenship and Immigration Services?
MI MADRE TIENE UNA PETICIÓN
VIGENTE, DESDE HACE
Explain: APROXIMADAMENTE ANOS YA
QUE LA MISMA ES RESIDENTE
LEGAL
U.S. Contact Information
BONILLA DE GONDRE, YLDA
Contact Person Name in the U.S.:
MERCEDES
Organization Name in the U.S.: DO NOT KNOW
Relationship to You: RELATIVE
U.S. Contact Address: 3326 A5
UNION CITY, NEW JERSEY 07087
Phone Number: 8493518745
Email Address: DOES NOT APPLY
Family Information
Father's Surnames: DO NOT KNOW
Father's Given Names: DO NOT KNOW
Mother's Surnames: BONILLA DE GONDRE
Mother's Given Names: YLDA MERCEDES
Mother's Date of Birth: 13 JULY 1950
Is your mother in the U.S.? YES
U.S. LEGAL PERMANENT RESIDENT
Status:
(LPR)
Do you have any immediate relatives, not
YES
including parents in the U.S.?
Relative Name (1): GONDRE BONILLA, CARMELINA
Relationship to you: SIBLING
Status: U.S. CITIZEN
Work/Education/Training Information
Primary Occupation: OTHER
ME DEDICO A LA AGRICULTURA Y
Specify Other:
TRABAJO POR MI PROPIA CUENTA.
Present Employer or School Name: AGRICULTURA
Address: VERAGUA
City: GASPAR HERNANDEZ
State/Province: ESPAILLAT
Postal Zone/Zip Code: DOES NOT APPLY
Country/Region: DOMINICAN REPUBLIC
Work Phone Number: 8097390838
Monthly Salary in Local Currency (if
40000
employed):
ME DEDICO A LA AGRICULTURA DE
Briefly Describe your Duties:
PLÁTANOS, YUCA, BATATA.
 TAMBIÉN ME DEDICO A LA
CRIANZA DE ANIMALES PARA
LUEGO VENDERLOS.
Were you previously employed? NO
Have you attended any educational
NO
institutions at a secondary level or above?
Do you belong to a clan or tribe? NO
Provide a List of Languages You Speak:
Language Name (1): ESPANOL
Have you traveled to any countries/regions
NO
within the last five years?
Have you belonged to, contributed to, or
worked for any professional, social, or NO
charitable organization?
Do you have any specialized skills or
training, such as firearms, explosives, NO
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 paramilitary unit,
NO
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, gonorrhea,
granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious NO
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
NO
the safety or welfare of yourself or others?
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
NO
subject of a pardon, amnesty, or other similar action?
Have you ever violated, or engaged in a conspiracy to violate, any law relating to
NO
controlled substances?
Are you coming to the United States to engage in prostitution or unlawful
commercialized vice or have you been engaged in prostitution or procuring NO
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
NO
the United States or outside the United States?
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
NO
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 human trafficking offense in the NO
United States or outside the United States?
Do you seek to engage in espionage, sabotage, export control violations, or any
NO
other illegal activity while in the United States?
Do you seek to engage in terrorist activities while in the United States or have you
NO
ever engaged in terrorist activities?
Have you ever or do you intend to provide financial assistance or other support to
NO
terrorists or terrorist organizations?
Are you a member or representative of a terrorist organization? NO
Have you ever ordered, incited, committed, assisted, or otherwise participated in
NO
genocide?
Have you ever committed, ordered, incited, assisted, or otherwise participated in
NO
torture?
Have you committed, ordered, incited, assisted, or otherwise participated in
NO
extrajudicial killings, political killings, or other acts of 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
NO
carried out, at any time, particularly severe 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 abortion against her free NO
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
NO
organs or bodily tissue?
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 NO
misrepresentation or other unlawful means?
Have you ever withheld custody of a U.S. citizen child outside the United States
NO
from a person granted legal custody by a U.S. court?
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
NO
taxation?
Location Information
Location where you will be submitting your application
SANTO DOMINGO, DOMINICAN
Current Location:
REPUBLIC
Preparer of Application
Did anyone assist you in filling out this
NO
application?
Your Personal Copy -- Do Not Bring to Interview
Usted firmó su solicitud de manera electrónica el 20-Mar-2018 11:23:01 (GMT-05:00).
Se le requirió firmar su solicitud personalmente y de manera electrónica al menos que
por reglamento quede exento de ello y aún si el formulario fue elaborado a su nombre
por alguien más. Su firma electrónica certifica que usted ha leído y entendido las
preguntas en su solicitud de Visa de No-Inmigrante y que además todas sus respuestas
son verdaderas y realizadas a su mejor entender y convicción. La entrega de una
solicitud conteniendo declaraciones falsas y engañosas pueden resultar en la negativa
permanente de una visa para entrar a los Estados Unidos de Norteamérica. Todas las
declaraciones hechas en esta solicitud no están sujetas a juramento pero deben ser
hechas bajo protesta de decir verdad. (28 U.S.C. 1746).

La información que usted ha proporcionado en su solicitud y alguna otra enviada junto

con ésta, puede ser puesta a disposición de otras agencias del gobierno con el derecho y
la autoridad legal que les confiere para usar dicha información, incluso para propósitos
del órden público y leyes de inmigración. Si se obtienen huellas dactilares como parte
de su proceso de solicitud, éstas pueden ser usadas con el propósito de compararlas con
otras huellas dactilares en el Sistema de Identificación de Siguiente Generación (Next
Generation Identification System) NGI por sus siglas en inglés, de la Oficina Federal de
Investigación (Federal Bureau of Investigation - FBI por sus siglas en inglés) o por sus
sistemas subsecuentes (incluyendo civiles, criminales y archivos existentes de huellas
dactilares). La fotografía que proporcione junto con su solicitud puede ser utilizada para
verificación de empleo u otros propósitos competentes a la