Scribd
Upload
90 views3 pages

Yanie

The document contains details from an Indonesian family's nonimmigrant visa application including personal information, addresses, dates of previous visits to the US, and family members traveling. The purpose of the trip is listed as vacation for two weeks to visit Disney world in Orlando, Florida.

Uploaded by

Triyani Sekartini
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
90 views3 pages

Yanie

The document contains details from an Indonesian family's nonimmigrant visa application including personal information, addresses, dates of previous visits to the US, and family members traveling. The purpose of the trip is listed as vacation for two weeks to visit Disney world in Orlando, Florida.

Uploaded by

Triyani Sekartini
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

5/31/2011

B793420 Bandung INDONESIA West java

INDONESIA 01 NOVEMBER 2006 01 NOVEMBER 2011

Sekartini

Triyani

21 APRIL 1979

INDONESIA
Bandung INDONESIA West java

Jln.Purwakarta 3 No.30 Antapani


1050176104795001 Bandung, West Java 40291
X INDONESIA

022-76797219 0817204155

X Dadan Sumarlan
11 FEBRUARY 1978
Jln.Kopo Sayati No.258 A
PT. BPR Duta Pasunda Bandung

Staff Office 24 JANUARY 2010

6825 Visitor's Circle at Intl Dr


Orlando, Florida 32819

O1Z80CCTRM
Disney world

Vacation
2 weeks

X
ourselve

5-2008
X X

X X

Dadan Sumarlan (Husband)


Daffa Sumarlan (Son)
Hazel Winatra Sumarlan (Son)

X X

X X X
X X

X
X

Dadan Sumarlan Husband


Jln.Purwakarta 3 no.30, Antapani Bandung
U.S. Department of State
SUPPLEMENT TO
NONIMMIGRANT VISA APPLICATION

PLEASE BE SURE TO SUBMIT THIS PAGE WITH THE REST OF YOUR APPLICATION

DO NOT MARK OR WRITE IN THIS SPACE

Triyani Sekartini

Barcode Number: O1Z80CCTRM


29. Additional Visits to the U.S.:

30. Additional Visa Issuances:

31. Additional Visa Refusals:

EVAF 02.02.12

You might also like