Consular Electronic Application Center - Print Application https://ceac.state.gov/GenNIV/common/printapplication.aspx?rwEgGC...

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: KALVA, HIMANSHU LALBHAI

Full Name in Native Language: HIMANSHU LALBHAI KALVA

Other Names Used: NO

Telecode Name Used: NO

Sex: MALE

Marital Status: MARRIED

Date of Birth: 06 FEBRUARY 1982

Place of Birth: PALANPUR, GUJARAT, INDIA

Country/Region of Origin (Nationality): INDIA

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: DOES NOT APPLY

U.S. Social Security Number: 149233845

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: 137 SNOWDEN ST E

Your Personal Copy -- Do Not Bring to Interview

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Your Personal Copy -- Do Not Bring to Interview

City: FRANKLIN

State/Province: TENNESSEE

Postal Zone/ZIP Code: 37064

Country/Region: UNITED STATES OF AMERICA

Same Mailing Address? YES

Primary Phone Number: +12019823064

Secondary Phone Number: +15163149015

Work Phone Number: +16153204200

Do you have any additional phone numbers? NO

Email Address: [email protected]

Do you have any additional email addresses? NO

Do you have a social media presence?

Social Media Platform: (1): FACEBOOK

Social Media Identifier: HIMANSHU KALVA

Do you have any additional social media presence? NO

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: K4696016

Passport Book Number: DOES NOT APPLY

Country/Authority that Issued Passport/Travel Document: INDIA

City Where Issued: WASHINGTON

State/Province Where Issued: DC

Country/Region Where Issued: UNITED STATES OF AMERICA

Issuance Date: 31 DECEMBER 2012

Expiration Date: 30 DECEMBER 2022

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): TEMPORARY WORKER (H)

Specify: SPECIALTY OCCUPATION (H1B)

Application Receipt/Petition Number: LIN2030850639

Have you made specific travel plans? NO

Intended Date of Arrival: 07 MARCH 2022

Intended Length of Stay in U.S.: 3 YEAR(S)

Address where you will stay in the U.S.: 137 SNOWDEN ST E

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): MAHESHWARI, VAISHALI SHISHUPAL

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Relationship to You: SPOUSE

Have you ever been in the U.S.? YES

Date Arrived (1): 03 MARCH 2018

Length of Stay: 3 YEAR(S)

Date Arrived (2): 30 NOVEMBER 2015

Length of Stay: 3 YEAR(S)

Do you or did you hold a U.S. Driver's License? YES

Driver's License Number (1): 132102937

State of Driver's License: TENNESSEE

Have you ever been issued a U.S. Visa? YES

Date Last Visa was Issued: 20 NOVEMBER 2017

Visa Number: M6254206

Are you applying for the same type of visa? YES

Are you applying in the same country where the visa above is issued YES
and is this country your principal country of residence?

Have you been ten-printed? YES

Has your U.S. Visa ever been lost or stolen? NO

Has your U.S. Visa ever been cancelled or revoked? 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 YES
United States Citizenship and Immigration Services?

Explain: DAVITA INC FILED FOR MY H1B VI

SA

U.S. Contact Information

Contact Person Name in the U.S.: MAHESHWARI, VAISHALI SHISHUPAL

Organization Name in the U.S.: SELF

Relationship to You: SPOUSE

U.S. Contact Address: 137 SNOWDEN ST E

FRANKLIN, TENNESSEE 37064

Phone Number: 5163149015

Email Address: [email protected]

Family Information
Father's Surnames: KALVA

Father's Given Names: LALBHAI DAMODARDAS

Father's Date of Birth: 11 NOVEMBER 1947

Is your father in the U.S.? NO

Mother's Surnames: KALVA

Mother's Given Names: RAMILA LALBHAI

Mother's Date of Birth: 14 JULY 1954

Is your mother in the U.S.? NO

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Your Personal Copy -- Do Not Bring to Interview

Do you have any immediate relatives, not including parents in the U.S.? YES

Relative Name (1): MAHESHWARI, VAISHALI SHISHUPAL

Relationship to you: SPOUSE

Status: NONIMMIGRANT

Spouse's Full Name: MAHESHWARI, VAISHALI SHISHUPAL

Spouse's Date of Birth: 21 MAY 1985

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

Spouse's City of Birth: AHMEDABAD

Spouse's Country/Region of Birth: INDIA

Spouse’s Address: SAME AS HOME ADDRESS

Work/Education/Training Information
Primary Occupation: OTHER

Specify Other: SR. QUALITY ASSURANCE ANALYST

Present Employer or School Name: DAVITA INC

Address: 5200 VIRGINIA WAY

City: BRENTWOOD

State/Province: TENNESSEE

Postal Zone/Zip Code: 37027

Country/Region: UNITED STATES OF AMERICA

Work Phone Number: +16153204200

Monthly Salary in Local Currency (if employed): 7600

Briefly Describe your Duties: WORKING WITH DEV AND BA TEAM T

O DESIGN TESTING PLAN AND TEST
DOCUMENTS TEST ALL UI APPLI
CATION AND DATABASE WORKING
WITH CROSS FUNCTION TEAM. UPD
ATING PROJECT MANAGER ON DAILY
BASIS ABOUT THE PROGRESS OF
TESTING ACTIVITIES.

Were you previously employed? YES

Employer Name (1): NEW ENGLAND IT ASSOCIATES

Employer Address: 15 NEW

ENGLAND
EXECUTIVE
PARK

City: BURLINGTON

State/Province: MA

Postal Zone/Zip Code: 01803

Country/Region: UNITED STATES OF AMERICA

Telephone Number: 7816644899

Job Title: BUSINESS ANALYST

Supervisor's Surname: BIRUDAVOLU

Supervisor's Given Name: KARTHIK

Employment Date From: 01 OCTOBER 2013

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Employment Date To: 22 MARCH 2015

Briefly describe your duties: GATHER AND ANALYZE DATA FRO PO

TENTIAL BUSINESS EXPANSION I
NFLUENCE STAKEHOLDERS TO
SUPPO
RT BUSINESS PROJECTS ASSIST W
ITH PROJECT MANAGEMENT FOR SEL
ECTED PROJECTS COORDINATE WIT
H DIFFERENT DEPARTMENTAL TEAMS
TO PRODUCE BETTER BUSINESS OU
TCOMES TEST BUSINESS PROCESS
ES AND RECOMMEND
IMPROVEMENTS

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

above?

Name of Institution (1): GOLDEY BEACOME COLLEGE

Address of Institution: 4701 LIMESTONE ROAD

City: WILMINGTON

State/Province: DELAWARE

Postal Zone/ZIP Code: 19808

Country/Region: UNITED STATES OF AMERICA

Course of Study: MASTER OF BUSINESS ADMINISTRATION

Date of Attendance From: 20 OCTOBER 2008

Date of Attendance To: 10 MAY 2010

Name of Institution (2): SK PATEL INSTITUTE OF MANAGEMENT AND

COMPUTER STUDIES

Address of Institution: KADI CAMPUS

NEAR GH 6, SECTOR 23

City: GANDHINAGAR

State/Province: GUJARAT

Postal Zone/ZIP Code: 382023

Country/Region: INDIA

Course of Study: MASTER OF BUSINESS ADMINISTRATION IN

MARKETING

Date of Attendance From: 01 JULY 2004

Date of Attendance To: 30 JUNE 2006

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): ENGLISH

Language Name (2): HINDI

Language Name (3): GUJARATI

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
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

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Your Personal Copy -- Do Not Bring to Interview

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 NO
include chancroid, 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 NO
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 subject of a pardon, amnesty, or NO
other similar 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 NO
engaged in 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 NO
United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human NO
trafficking offense in the 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 NO
commit a severe 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 NO
United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist NO
activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist NO
organizations?

Are you a member or representative of a terrorist organization? NO

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing NO
financial assistance or other support to terrorists or terrorist organizations, in the last five years?

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, NO
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 carried out, at any time, NO
particularly severe violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a NO
woman to undergo an 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 been the subject of a removal or deportation hearing? NO

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United NO
States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you failed to attend a hearing on removability or inadmissibility within the last five years? NO

Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or NO
otherwise violated the terms of a U.S. visa?

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Your Personal Copy -- Do Not Bring to Interview

Have you ever been removed or deported from any country? NO

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal NO
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 taxation? NO

Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement? NO

Have you attended a public elementary school on student (F) status or a public secondary school after November NO
30, 1996 without reimbursing the school?

Temporary Work Visa Information

Application Receipt/Petition Number: LIN2030850639

Name of Person/Company who Filed Petition: GRAHAM ADAIR, INC.

Where Do You Intend to Work?

Name of Employer: DAVITA INC

Street Address: 5200 VIRGINIA WAY

BRENTWOOD, TENNESSEE 37027

Phone Number: 6153204200

Monthly Income (in USD): $7,600

Location Information
Location where you will be submitting your application

Current Location: MUMBAI, INDIA

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

Your Personal Copy -- Do Not Bring to Interview

You electronically signed your application on 06-Dec-2021 10:19:08 (GMT-05:00). You were required to electronically sign your
application yourself, unless otherwise exempt by regulation, even if the application was prepared by someone other than yourself.
Your electronic signature certifies that you have read and understood the questions in this application and that your answers are true
and correct to the best of your knowledge and belief. The submission of an application containing any false or misleading statements
may result in the permanent refusal of a visa or the denial of entry into the United States. All declarations made in this application
are unsworn declarations made under penalty of perjury. (28 U.S.C. 1746).

You certified that you understand that you are required to submit your visa to the United States Immigration Officer at the port
where you apply to enter the United States, and that possession of the visa does not entitle you to enter the United States if, upon
your arrival, you are found to be inadmissible under U.S. immigration laws. You certified that you understand that any willfully false
or misleading statement or willful concealment of a material fact made by you within the application may subject you to permanent
exclusion from the United States and, if you are admitted to the United States, may subject you to criminal prosecution and/or
deportation.

The information that you have provided in your application and other information submitted with your application may be accessible
to other government agencies having statutory or other lawful authority to use such information, including for law enforcement and
immigration law enforcement purposes. If fingerprints are collected as part of your application process, they may be used for the
purpose of comparing them to other fingerprints in the FBI’s Next Generation Identification (NGI) fingerprint system or its successor
systems (including civil, criminal, and latent fingerprint repositories). The photograph that you provide with your application may be
used for employment verification or other U.S. law purposes.

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