3/1/2018 Consular Electronic Application Center - Print Application

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: GARCIA VILLALOBOS, NELSON JAVIER

Full Name in Native Language: DOES NOT APPLY

Other Names Used: NO

Telecode Name Used: NO

Sex: MALE

Marital Status: MARRIED

Date of Birth: 06 JUNE 1977

Place of Birth: MEDELLIN, ANTIOQUIA, COLOMBIA

Country/Region of Origin (Nationality): COLOMBIA

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: 71787547

U.S. Social Security Number: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: TRANSVERSAL 45B # 84-40

APTO 1403

City: MEDELLIN

State/Province: ANTIOQUIA

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: COLOMBIA

Same Mailing Address? YES

Primary Phone Number: 3012651237

Secondary Phone Number: DOES NOT APPLY

Work Phone Number: 3117332

Email Address: [email protected]

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: AO732078

Your Personal Copy -- Do Not Bring to Interview

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Your Personal Copy -- Do Not Bring to Interview

Passport Book Number: DOES NOT APPLY

Country/Authority that Issued Passport/Travel Document: COLOMBIA

City Where Issued: MEDELLIN

State/Province Where Issued: G. ANTIOQUIA

Country/Region Where Issued: COLOMBIA

Issuance Date: 25 JUNE 2013

Expiration Date: 25 JUNE 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): TEMP. BUSINESS PLEASURE VISITOR (B)

Specify: BUSINESS & TOURISM (TEMPORARY VISITOR) (B1/B2)

Have you made specific travel plans? NO

Intended Date of Arrival: 10 FEBRUARY 2018

Intended Length of Stay in U.S.: 15 DAY(S)

Address where you will stay in the U.S.: 49 HOPKINS DR NEWINGTON

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): SANCHEZ VELEZ, LUZ DORIS

Relationship to You: SPOUSE

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.: VEILLEUX, MARTHA N

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

Relationship to You: OTHER

U.S. Contact Address: 49 HOPKINS DR NEWINGTON

NEWINGTON, CONNECTICUT 06111

Phone Number: 8608419031

Email Address: [email protected]

Family Information
Father's Surnames: GARCIA

Father's Given Names: JOSE BERNARDO

Father's Date of Birth: DO NOT KNOW

Is your father in the U.S.? NO

Mother's Surnames: VILLALOBOS VILLALOBOS

Mother's Given Names: LUCILA

Mother's Date of Birth: 16 JANUARY 1939

Is your mother in the U.S.? NO

Do you have any immediate relatives, not including parents in the U.S.? NO

Do you have any other relatives in the United States? YES

Your Personal Copy -- Do Not Bring to Interview

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Spouse's Full Name: SANCHEZ VELEZ, LUZ DORIS

Spouse's Date of Birth: 01 SEPTEMBER 1967

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

Spouse's City of Birth: MEDELLIN

Spouse's Country/Region of Birth: COLOMBIA

Spouse’s Address: SAME AS HOME ADDRESS

Work/Education/Training Information
Primary Occupation: OTHER

Specify Other: ECONOMY

Present Employer or School Name: MEGALINEA-BANCO DE BOGOTA

Address: CARRERA 43A # 7-50A

City: MEDELLIN

State/Province: ANTIOQUIA

Postal Zone/Zip Code: DOES NOT APPLY

Country/Region: COLOMBIA

Work Phone Number: 3117332

Monthly Salary in Local Currency (if employed): 6500000

Briefly Describe your Duties: SPECIALIST IN MORTGAGE CREDIT

Were you previously employed? YES

Employer Name (1): BANCAMIA SA

Employer Address: CARRERA

9 #66-25

City: BOGOTA

State/Province: CUNDINAMARCA

Postal Zone/Zip Code: DOES NOT APPLY

Country/Region: COLOMBIA

Telephone Number: 3139300

Job Title: MICROFINANCE EXECUTIVE

Supervisor's Surname: ALZATE

Supervisor's Given Name: LUIS

Employment Date From: 01 SEPTEMBER 2009

Employment Date To: 31 JULY 2013

Briefly describe your duties: CREDIT ANALYSIS

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

above?

Name of Institution (1): EAFIT

Address of Institution: CARRERA 49 #7SUR-50

City: MEDELLIN

State/Province: ANTIOQUIA

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: COLOMBIA

Course of Study: ECONOMY

Date of Attendance From: 21 JANUARY 1997

Date of Attendance To: 10 DECEMBER 2003

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): SPANISH

Have you traveled to any countries/regions within the last five years? NO

Have you belonged to, contributed to, or worked for any professional, NO

Your Personal Copy -- Do Not Bring to Interview

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Your Personal Copy -- Do Not Bring to Interview

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

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: BOGOTA, COLOMBIA

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

Your Personal Copy -- Do Not Bring to Interview

Usted firmó su solicitud de manera electrónica el 03-Jan-2018 10:05:57 (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).

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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 legislación de los Estados Unidos de Norteamérica.

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