DS - 160

Personal, Address, Phone, and Passport Information

Name Provided: Mayur Singh ladad
Full Name in Native Language:
Other Names Used:
Sex: male
Marital Status: single
Date of Birth: 18th July 1988
Place of Birth: Mumbai
Nationality: Indian
Other Nationalities: none
National Identification Number:
U.S. Social Security Number:
U.S. Taxpayer ID Number:
A/103 jai regency parshwa nagar behind old petrol pump mira-
Home Address:
bhayander rd mira road (E)

City: Thane
State/Province:
Postal Zone/ZIP Code: 401107
Country: India
Same Mailing Address?
Home Phone Number: 9619589090
Work Phone Number: 7045901991
Work Fax Number:
Mobile/Cell Phone Number: 9702513116
Email Address: Singh_mayur2000@yahoo.com
Passport Number: H7068907
Passport Book Number: H7068907
Country/Authority that Issued Passport: India
City Where Issued: Thane
Country Where Issued: India
Issuance Date: 18/11/2009
Expiration Date: 17/11/2019
Have you ever lost passport / had one stolen NO
Travel Information
Principal Applicant?
Purpose of Your Trip to U.S. travel
Intended Date of Arrival:
Intended Length of Stay in U.S.:
Address where you will stay in the U.S:

Person/Entity Paying for Your Trip:

Address:
Tel No:
Relation:
Other Persons Traveling with You:

Are you traveling as part of a group or

organization?
Persons Traveling with You:
Name (1) :
Relationship to You:
Name (2) :
Relationship to You:
Name (3) :
Relationship to You:

Have you ever been in the U.S.? if traveled

Yes 28 July 2014 28 July 2015
please provide date of travel and number of
days stayed in USA (each visit)
Have you ever been issued a U.S. visa?,
please provide, date of issue of visa, place of Yes Mumbai 17 july2014 Mumbai
visa, visa class and visa number
Have you ever been refused a U.S. Visa,
been refused admission to the United States,
no
or withdrawn your application for admission
at the point of entry?
U.S. Contact Information
Contact Person Name in the U.S.:
Organization Name in the U.S.:
Relationship to You:
U.S. Contact Address:

Phone Number:
Email Address:
Family Information
Father's Surnames: ladad
Father's Given Names: Santoshsingh dayal ladad
Father's Date of Birth: 26/ 02/1960
Is your father in the U.S.? no
Mother's Surnames: ladad
Mother's Given Names: Sumansingh santoshsingh ladad
Mother's Date of Birth: 12/06/1964
Is your mother in the U.S.? NO

Do you have any immediate relatives, not NO

including parents in the U.S.?
Relative Name (1) :
Relationship to you:
Status:
Spouse's Full Name:
Spouse's Date of Birth:
Spouse's Nationality:
Spouse's City of Birth:
Spouse's Country of Birth:
Spouses Address:
Work / Education / Training Information
Primary Occupation: (designation) executive chef
Present Employer or School Name :Sk restaurants private limited
Address: sanjeev kapoors office fun republic mall dalia estate andheri west next to barbecue nation.

City & State / Province: Mumbai Maharashtra

Postal Zone/Zip Code:400053
Country :India
Month Salary in Local Currency: 30,000
Briefly Describe your Duties: I am responsible for making sure the kitchen is adequately staffed in all
areas, and that employees receive the necessary training to ensure quality culinary dishes are
produced. Assigns duties to his or her staff, such as food preparation tasks, or assigned line
positions. Cooking.

Were you previously employed?

Employer Name (1) ITC MARATHA
EmployerAddress: Sahar road andheri east near sahar gaon

City: Mumbai
State/Province: Maharashtra
PostalZone/ZipCode: 400099
Country: India
Telephone Number:
Job Title: Chef de partie
Supervisor's Name:
Employment DateFrom:
Employment Date To:
Briefly describe your duties:

Have you attended any educational institutions other than elementary schools?
Name of Institution (1) : Kohinoor institute of hotel management and business
Address of Institution: Khandala

City: Pune
State/Province: Maharashtra
Postal Zone/ZIP Code: 410301
Country: India
Course of Study: India
Date of Attendance From:
Date of Attendance To:

Do you belong to a clan or tribe? no

Do you have any specialized skills or
training, including firearms, explosives, no
nuclear, biological, or chemical experience?
Have you ever served in, been a member of,
or been involved with a paramilitary unit,
no
vigilante unit, rebel group, guerrilla group,
or insurgent organization?
Security and Background Information
Do you have a communicable disease of
public health significance such as no
tuberculosis (TB)?
Do you have a mental or physical disorder
that poses or is likely to pose a threat to the no
safety or welfare of yourself or others?
Are you or have you ever been a drug abuser
no
or addict?
Have you ever been arrested or convicted for
any offense or crime, even though subject of
a pardon, amnesty, or other similar action? 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
no
seek to engage in, money laundering?
Do you seek to engage in espionage,
sabotage, export control violations, or any
no
other illegal activity while in the United
States?
Do you seek to engage in terrorist activities
while in the United States or have you ever no
engaged in terrorist activities?
Have you ever or do you intend to provide
financial assistance or other support to no
terrorists or terrorist organizations?
Are you a member or representative of a
no
terrorist organization?
Have you ever ordered, incited, committed,
assisted, or otherwise participated in no
genocide?
Have you ever committed, ordered, incited,
no
assisted, or otherwise participated in torture?
Have you committed, ordered, incited,
assisted, or otherwise participated in
no
extrajudicial killings, political killings, or
other acts of violence?
Have you, while serving as a government no
official, been responsible for or directly
carried out, at any time, particularly severe
violations of religious freedom?
Have you ever sought to obtain or assist
others to obtain a visa, entry into the United
States, or any other United States no
immigration 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
no
person granted legal custody by a U.S.
court?
Have you voted in the United States in
no
violation of any law or regulation?
Have you ever renounced United States
citizenship for the purpose of avoiding no
taxation?
Languages Known to Read, Write and
English, hindi, Marathi, Punjabi.
Speak
Countries visited in the past 5 years Usa ,Switzerland