Special Immigrant Visa Biodata Form
18. Other Language(s)
17. Native Language
16. Education Level/Field of Study
15. Last Occupation/Skill
14. E-mail
3. If not, what is your relationship to the PA?
(Husband, wife, son, daughter)
1. Case Size (Yourself plus family members
traveling with you)
2. Are you the principal applicant (PA)?
Yes No
4. Name as it Appears on your Passport (Last, First, Middle) 5. Sex
Male Female
6. Marital Status 7. Date of Birth (mm-dd-yyyy) 8. Place of Birth (City, Country)
9. Nationality 10. Ethnicity 11. Religion
12. Physical Address
13. Phone Number(s)
19. English Speaking Ability (Good, Some, None)
20. Health Issues (Condition, Treatment, Pregnancy, Urgency, Comments)
B. CASE MEMBER
U.S. Department of State
SPECIAL IMMIGRANT VISA BIODATA FORM
Bureau of Population, Refugees and Migration
Special immigrant visa applicants who qualify for and request resettlement assistance from the Department of State must complete this form for each
family member and submit it via email as a scanned attachment to the National Visa Center at [email protected] .
A. CASE INFORMATION (To be completed by NVC)
NVC Case Number Assigned Post Post POC Information
Submit one copy of the Special Immigrant Visa Biodata form for each family member.
Send completed form(s) to the National Visa Center as an email attachment at [email protected] .
DS-234
01-2013
OMB APPROVAL NO. 1405-0203
EXPIRES: 01-31-2016
ESTIMATED BURDEN: 20 MIN.
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C. CROSS REFERENCE
21. Do you have other immediate family members being processed on their own special immigrant visas?
Yes No
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