Personal, Address, Phone, and Passport Information

1 11/18/13 Non-Immigrant Visa - Review Personal, address , Phone, and Passport ID AA003 OHNPCP rintOnline Nonimmigrant Visa Application (DS-160)Personal, address , Phone, and Passport InformationNote: You have completed data entry for your NIV application. Before submitting the application, please review your entries navigate to the next section to be reviewed, click the Next button on the bottom of the page. If an entry is incorrect, click on thelinks on the right side of the page, which will direct you to the page where you entered the data. Once you have reviewed allsections, you will be directed to the Sign and Submit page to complete the application Provided:Upload New PhotoDO NOT BRING THIS TO YOUR INTERVIEWEdit Personal InformationName Provided:TAN, JANEFull name in Native Alphabet:JANE AU TAN Other Names Used:NOTelecode name Used:NOSex:FEMALEM arital Status:SINGLEDate of Birth:12 FEBRUARY 1981 Country/Region of Birth:SINGAPORE, SINGAPOREC ountry/Region of Origin (Nationality):SINGAPOREDo you hold or have you held any nationality other than the oneindicated above on nationality?

2 NONational Identification Social Security Number:DOES NOT taxpayer ID Number:DOES NOT APPLYEdit address and Phone InformationHome address :345 HOUGANG RDCity:SINGAPORES tate/Province:DOES NOT APPLYP ostal Zone/ZIP Code:98789 Country/Region:SINGAPORESame mailing address ?YESP rimary Phone Number:08977654 Secondary Phone Number:DOES NOT APPLY11/18/13 Non-Immigrant Visa - Review Personal, address , Phone, and Passport Phone Number:DOES NOT APPLYE mail Passport /Travel Document InformationPassport/Travel Document Type:REGULARP assport/Travel Document Number:33877265 Passport Book Number:DOES NOT APPLYC ountry/Authority that Issued Passport /Travel Document:SINGAPORECity where issued:SINGAPOREC ountry/Region where issued:SINGAPOREI ssuance Date:12 FEBRUARY 2012 Expiration Date:12 FEBRUARY 2022 Have you ever lost a Passport or had one stolen?

3 NODO NOT BRING THIS TO YOUR INTERVIEW11/18/13 Non-Immigrant Visa - Review Travel ID AA003 OHNPCO nline Nonimmigrant Visa Application (DS-160)Travel InformationDO NOT BRING THIS TO YOUR INTERVIEWEdit Travel Information The List of Purposes of Trip to the of Trip to the (1):FIANC (E) OR SPOUSE OF A CITIZEN(K)Specify:FIANC (E) OF A CITIZEN (K1)Application Receipt/Petition Number:MSC3243355334 Intended Date of Arrival:02 FEBRUARY 2014 address where you will stay in the :2355 LINCOLN BLVDLOS ANGELES, CALIFORNIA 90234 Person/Entity Paying for Your PETITIONEREdit Travel Companions InformationOther Persons Traveling with You:NOEdit Previous Travel Information Have you ever been in the Arrived (1):08 APRIL 2009 Length of Stay:2 WEEK(S)Do you or did you ever hold a Driver's License?

4 NOHave you ever been issued a visa?NOHave you ever been refused a Visa, or been refused admissionto the United States, or withdrawn your application for admission atthe port of entry?NOHave you ever been denied travel authorization by the Department ofHomeland Security through the Electronic System for TravelAuthorization (ESTA)?NOHas anyone ever filed an immigrant petition on your behalf with theUnited States Citizenship and Immigration Services?NODO NOT BRING THIS TO YOUR INTERVIEW11/18/13 Nonimmigrant Visa - Review US Contact ID AA003 OHNPCP rintOnline Nonimmigrant Visa Application (DS-160) Contact InformationDO NOT BRING THIS TO YOUR INTERVIEWEdit Point of Contact InformationContact Person name in the :SMITH, JOHNO rganization name in the :DO NOT KNOWR elationship to PETITIONERDO NOT BRING THIS TO YOUR INTERVIEW11/18/13 Nonimmigrant Visa - Review Family ID AA003 OHNPCO nline Nonimmigrant Visa Application (DS-160)Family InformationDO NOT BRING THIS TO YOUR INTERVIEWEdit Family Information : RelativesFather's Surnames:TANF ather's Given Names:MICHAELF ather's Date of Birth:06 APRIL 1955Is your father still living?

5 YESF ather's address :4565 SILOM RDCity:SINGAPORES tate/Province:DOES NOT APPLYP ostal Zone/ZIP Code:77467 Country/Region:SINGAPOREIs your father in the 's Surnames:TANM other's Given Names:JULIAM other's Date of Birth:12 JUNE 1958Is your mother still living?YESM other's address :4565 SILOM RDCity:SINGAPORES tate/Province:DOES NOT APPLYP ostal Zone/ZIP Code:SINGAPOREC ountry/Region:SINGAPOREIs your mother in the you have any immediate relatives, not including parents in you have any other relatives in the United States?NOEdit Family Information : Fianc /Fianc eFianc /Fianc e's Full name :SMITH, JOHNF ianc /Fianc e's Date of Birth:05 JUNE 1980 Fianc /Fianc e's address :2355 LINCOLN BLVDCity:LOS ANGELESS tate/Province:CALIFORNIAP ostal Zone/ZIP Code:90234 Fianc /Fianc e's Occupation:COMPUTER SCIENCEEdit Family Information : Former Spouse(s)11/18/13 Nonimmigrant Visa - Review Family you have any former spouses?

6 NOEdit Family Information : ChildrenDo you have any children?NODO NOT BRING THIS TO YOUR INTERVIEW11/18/13 Nonimmigrant Visa - Review Work / Education ID AA003 OHNPCO nline Nonimmigrant Visa Application (DS-160)Work / Education / Training InformationDO NOT BRING THIS TO YOUR INTERVIEWEdit Present Work InformationPrimary Occupation:ENGINEERINGP resent Employer or School name :INTELP resent Employer or School address :5534 ORCHARD RDCity:SINGAPORES tate/Province:DOES NOT APPLYP ostal Zone/Zip Code:79896 Country/Region:SINGAPOREWork Phone Number:087656764 Monthly Salary in Local Currency (if employed):14000 Briefly Describe your Duties:RESPONSIBLE FOR INTEL HASWELL PRODUCTIONQUALITY Additional InformationDo you belong to a clan or tribe?

7 NO Provide a List of Languages You Speak:Language name : (1):MANDARINL anguage name : (2):ENGLISH Have you traveled to any countries within the last five years?YESC ountry Visited (1):MALAYSIAHave you belonged to, contributed to, or worked for any professional,social, or charitable organization?NODo you have any specialized skills or training, including firearms,explosives, nuclear, biological, or chemical experience?NOHave you ever served in the military?NOHave you ever served in, been a member of, or been involved with aparamilitary unit, vigilante unit, rebel group, guerrilla group, orinsurgent organization?NODO NOT BRING THIS TO YOUR INTERVIEW11/18/13 Nonimmigrant Visa - Review Security ID AA003 OHNPCO nline Nonimmigrant Visa Application (DS-160)Security and Background InformationDO NOT BRING THIS TO YOUR INTERVIEWEdit Part 1Do you have a communicable disease of public health significance?

8 (Communicable diseases ofpublic significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy,lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases asdetermined by the Department of Health and Human Services.)NODo you have a mental or physical disorder that poses or is likely to pose a threat to the safety orwelfare of yourself or others?NOAre you or have you ever been a drug abuser or addict?NODo you have documentation to establish that you have received vaccinations in accordance law?YESEdit Part 2 Have you ever been arrested or convicted for any offense or crime, even though subject of apardon, amnesty, or other similar action?

9 NOHave you ever violated, or engaged in a conspiracy to violate, any law relating to controlledsubstances?NOAre you coming to the United States to engage in prostitution or unlawful commercialized vice orhave you been engaged in prostitution or procuring prostitutes within the past 10 years?NOHave you ever been involved in, or do you seek to engage in, money laundering?NOHave you ever committed or conspired to commit a human trafficking offense in the United States oroutside the United States?NOAre you the spouse, son, or daughter of an individual who has committed or conspired to commit ahuman trafficking offense in the United States or outside the United States and have you within thelast five years, knowingly benefited from the trafficking activities?

10 NOHave you knowingly aided, abetted, assisted or colluded with an individual who has committed orconspired to commit a severe human trafficking offense in the United States or outside the UnitedStates?NOAre you the spouse, son, or daughter of an individual who has been identified by the President ofthe United States as person who plays a siginificant role in a severe form in trafficking in personsand have you, within last five years, knowingly benefited from the trafficking activities?NOAre you the spouse, son, or daughter of an individual who has violated any controlled substancetrafficking law, and have knowingly benefited from the trafficking activities in the past five years?NOEdit Part 3Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activitywhile in the United States?