3/19/2019 Consular Electronic Application Center - Print Application

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: PAWAN KUMAR, FNU

Full Name in Native Language: PAWAN KUMAR

Other Names Used: NO

Telecode Name Used: NO

Sex: MALE

Marital Status: SINGLE

Date of Birth: 05 JANUARY 1992

Place of Birth: BEGUSARAI, BIHAR, 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: DOES NOT APPLY

U.S. Taxpayer ID Number: DOES NOT APPLY

Home Address: SRI KRISHNAPURI ROAD, I.M.A PATH

NEAR T.V TOWER

City: BEGUSARAI

State/Province: BIHAR

Postal Zone/ZIP Code: 851191

Country/Region: INDIA

Same Mailing Address? NO

Mailing Address: GLOBALLOGIC INDIA LTD

ADARSH PALM RETREAT, BELLANDUR

City: BANGALORE

State/Province: KARNATAKA

Postal Zone/ZIP Code: 560103

Country/Region: INDIA

Your Personal Copy -- Do Not Bring to Interview

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Primary Phone Number: 7903090560

Secondary Phone Number: DOES NOT APPLY

Work Phone Number: DOES NOT APPLY

Email Address: pawan.kumar6@globallogic.com

Passport/Travel Document Type: REGULAR

Passport/Travel Document Number: L9195172

Passport Book Number: DOES NOT APPLY

Country/Authority that Issued Passport/Travel Document: INDIA

City Where Issued: PATNA

State/Province Where Issued: BIHAR

Country/Region Where Issued: INDIA

Issuance Date: 03 JUNE 2014

Expiration Date: 02 JUNE 2024

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): TEMP. BUSINESS PLEASURE VISITOR (B)

Specify: BUSINESS & TOURISM (TEMPORARY VISITOR) (B1/B2)

Have you made specific travel plans? NO

Intended Date of Arrival: 30 MARCH 2019

Intended Length of Stay in U.S.: 2 WEEK(S)

Address where you will stay in the U.S.: CROWNE PLAZA ATLANTA PERIMETER

4355 ASHFORD DUNWOODY RD

City, State, Postal/Zip Code: ATLANTA, GEORGIA

Person/Entity Paying for Your Trip: COMPANY/ORGANIZATION

Company/Organization Paying for the Trip: GLOBALLOGIC INDIA LTD

Telephone Number: 08042576000

Relationship to You: EMPLOYER

Address of Company/Organization Paying: PRITECH PARK SEZ, 4TH FLOOR, BLOCK 12

BEHIND RMZ ECO SPACE, BELLANDUR

City: BANGALORE

State/Province: KARNATAKA

Postal Zone/ZIP Code: 560103

Country/Region: INDIA

Are there other persons traveling with you? NO

Have you ever been in the U.S.? NO

Have you ever been issued a U.S. visa? 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 NO
United States Citizenship and Immigration Services?

U.S. Contact Information

Contact Person Name in the U.S.: LANDGRAF, YURIY

Organization Name in the U.S.: DO NOT KNOW

Relationship to You: BUSINESS ASSOCIATE

U.S. Contact Address: GLOBALLOGIC INC

SAN JOSE, CALIFORNIA 95110

Phone Number: 4086385863

Email Address: DOES NOT APPLY

Family Information
Father's Surnames: SINGH

Father's Given Names: HARE KRISHNA

Your Personal Copy -- Do Not Bring to Interview

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Father's Date of Birth: 04 AUGUST 1965

Is your father in the U.S.? NO

Mother's Surnames: DEVI

Mother's Given Names: SHOBHA

Mother's Date of Birth: DO NOT KNOW

Is your mother in the U.S.? NO

Do you have any immediate relatives, not including parents in the U.S.? NO

Do you have any other relatives in the United States? NO

Work/Education/Training Information
Primary Occupation: ENGINEERING

Present Employer or School Name: GLOBALLOGIC INDIA LTD

Address: PRITECH PARK SEZ, 4TH FLOOR, BLOCK 12

BEHIND RMZ ECO SPACE, BELLANDUR

City: BANGALORE

State/Province: KARNATAKA

Postal Zone/Zip Code: 560103

Country/Region: INDIA

Work Phone Number: 0804257600

Monthly Salary in Local Currency (if employed): 125000

Briefly Describe your Duties: EMPLOYED AS AN ASSOCIATE CONSULTANT WHICH TAKES ALL KIND
OF PROJECT REQUIREMENT GATHERING , DEVELOPMENT AND
SUPPORT TO THE PROJECT.

Were you previously employed? YES

Employer Name (1): WIPRO LIMITED

Employer Address: DM
BLOCK,
SECTOR
5

SALT LAKE

City: KOLKATA

State/Province: WEST BENGAL

Postal Zone/Zip Code: 700091

Country/Region: INDIA

Telephone Number: 03344610100

Job Title: SENIOR PROJECT ENGINEER

Supervisor's Surname: GHOSH

Supervisor's Given Name: ANIMESH

Employment Date From: 13 AUGUST 2013

Employment Date To: 01 FEBRUARY 2019

Briefly describe your duties: CORE DEVELOPER

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

above?

Name of Institution (1): BP HIGH SCHOOL

Address of Institution: NEAR T.V TOWER

MATIHANI ROAD

City: BEGUSARAI

State/Province: BIHAR

Postal Zone/ZIP Code: 851101

Country/Region: INDIA

Course of Study: 10TH

Date of Attendance From: 05 JANUARY 2005

Date of Attendance To: 30 APRIL 2006

Name of Institution (2): NIOS

Address of Institution: BORING ROAD

City: PATNA

Your Personal Copy -- Do Not Bring to Interview

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State/Province: BIHAR

Postal Zone/ZIP Code: 800001

Country/Region: INDIA

Course of Study: 12TH

Date of Attendance From: 03 JANUARY 2007

Date of Attendance To: 30 MAY 2009

Name of Institution (3): BRINDAVAN COLLEGE

Address of Institution: BHOOPSANDRA

SANJAYNAGAR

City: BANGALORE

State/Province: KARNATAKA

Postal Zone/ZIP Code: 560094

Country/Region: INDIA

Course of Study: B.SC COMPUTER SCIENCE

Date of Attendance From: 01 AUGUST 2009

Date of Attendance To: 01 JUNE 2013

Name of Institution (4): BIRLA INSTITUTE OF TECHNOLOGY AND SCIENCE PILANI

Address of Institution: VIDYA VIHAR, PILANI

City: PILANI

State/Province: RAJASTHAN

Postal Zone/ZIP Code: 333031

Country/Region: INDIA

Course of Study: M.TECH

Date of Attendance From: 02 JANUARY 2013

Date of Attendance To: 30 NOVEMBER 2016

Do you belong to a clan or tribe? NO

Provide a List of Languages You Speak:

Language Name (1): ENGLISH

Language Name (2): HINDI

Have you traveled to any countries/regions within the last five years? YES

Provide a List of Countries/Regions Visited

Country/Region (1): BANGLADESH

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

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 include chancroid, NO
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 or others? NO

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 other similar NO
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 engaged in NO
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 United States? NO

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

Your Personal Copy -- Do Not Bring to Interview

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Your Personal Copy -- Do Not Bring to Interview

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 United States? NO

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

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

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

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, or other acts of NO
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, particularly severe NO
violations of religious freedom?

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a woman to undergo an NO
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 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 person granted legal custody by a U.S. NO
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

Location Information
Location where you will be submitting your application

Current Location: HYDERABAD, 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 19-Mar-2019 12:11:38 (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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