Пример заполнения формы на
DV LOTTERY-2009

ELECTRONIC DIVERSITY VISA ENTRY FORM Approved OMB 1405-0153 Expires: 04/30/2007 Estimated Burden: 30 minutes Part One - Applicant Information (Часть 1) 1. Name (ПОЛНОЕ ИМЯ - Фамилия-1a, имя-1b, отчество-1c - как записано в заграничном паспорте) 1a. Last/Family Name No Last/Family Name 1b. First Name No First Name 1c. Middle Name No Middle Name 2. Birth Date (ДАТА РОЖДЕНИЯ - Число, месяц, год) Select Day...12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901190018991898189718961895189418931892189118901889188818871886188518841883188218811880 3. Gender (ПОЛ - Мужской или женский) Male Female   4. City/Town of Birth (ГОРОД/СЕЛО, В КОТОРОМ РОДИЛСЯ) Birth City/Town Unknown 5. Country of Birth (СТРАНА, В КОТОРОЙ РОДИЛСЯ - Название страны, должно отвечать современному названию страны, в которой родились) Select A Country...AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic OfChina-TaiwanChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of TheCongo, Republic of TheCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambiaGazaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong Kong Special Administrative RegionHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau Special Administrative RegionMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorth KoreaNorthern IrelandNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWest BankWestern SaharaYemenZambiaZimbabwe 6. Primary Photograph (ФОТОКАРТОЧКА ПРЕТЕНДЕНТА - Смотрите для уточнения спецификации изображений) Please refer to the Instructions for the 2009 Diversity Immigrant Visa Program (DV-2009) for technical specifications and compositional specifications for the digital image. You will use one of the following methods to enter the image into eDV: Take a new digital image. Use a digital scanner to scan a submitted photograph. Specific instructions are included for both methods. Photograph File Name If you know the location in the computer and the name of the file which is storing the photograph, enter it in the box to the left of(the) 'Browse' button. If you are not sure of the location in the computer or the name of the file, clicking the 'Browse' button will allow you to look for and choose the file which is storing the photograph, and after you choose the file its name will appear in the box on the left. (Ссылка на размещение файла фотографии) 7. Mailing Address (ПОЧТОВЫЙ АДРЕС - Адрес, город/село, район/графство/провинция/штат, почтовый индекс, страна) 7a. In Care Of 7b. Address Line 1 7c. Address 2 7d. City/Town Stefanovka 7e. District/County/Province/State Kiev region 7f. Postal Code/Zip Code No Postal/Zip Code 7g. Country Select A Country...AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic OfChina-TaiwanChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of TheCongo, Republic of TheCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambiaGazaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong Kong Special Administrative RegionHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau Special Administrative RegionMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorth KoreaNorthern IrelandNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWest BankWestern SaharaYemenZambiaZimbabwe (NOTE: This is the address that will be used to notify you if you are selected.) 8. Phone Number (НОМЕР ТЕЛЕФОНА (если есть)) Optional 9. E-mail Address (АДРЕС ЭЛЕКТРОННОЙ ПОЧТЫ (если есть)) Optional 10. Country of Eligibility (ИЗБРАННАЯ СТРАНА, ЕСЛИ СТРАНОЙ ПРОИСХОЖДЕНИЯ ПРЕТЕНДЕНТА НЕ ЯВЛЯЕТСЯ СТРАНА ЕГО РОЖДЕНИЯ - Если претендент утверждает, что страна его рождения не считается страной его происхождения, эта информация должна быть указана в форме) Are you claiming eligibility based on your Birth Country? Yes No If not, you must enter the country from which you are claiming eligibility. Select A Country...AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCape VerdeCentral African RepublicChadChileChina-TaiwanChristmas IslandCocos IslandsComorosCongo, Democratic Republic of TheCongo, Republic of TheCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaEast TimorEcuadorEgyptEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHondurasHong Kong Special Administrative RegionHungaryIcelandIndonesiaIranIraqIrelandIsraelItalyJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau Special Administrative RegionMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMicronesia, Federated States ofMoldovaMonacoMongoliaMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorth KoreaNorthern IrelandNorwayOmanPalauPanamaPapua New GuineaParaguayPeruPolandPortugalQatarReunionRomaniaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. Pierre and MiquelonSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVatican CityVenezuelaWallis and FutunaWestern SaharaYemenZambiaZimbabwe 11. Are You Married? (ПРЕБЫВАНИЕ В БРАКЕ - Неженатый-1, состоящий в браке-2, разведённый-3, вдовец-4, женат проживаю отдельно-5, официально проживаю отдельно-6) Unmarried (no spouse info required) Married (spouse info required) Divorced (no spouse info required) Widowed (no spouse info required) Separated (spouse info required) Legally Separated (no spouse info required) 12. Number of Children (КОЛИЧЕСТВО ДЕТЕЙ ВОЗРАСТОМ ДО 21 ГОДА, КОТОРЫЕ НЕ НАХОДЯТСЯ В БРАКЕ, кроме детей, которые являются гражданами США или имеют статус Постоянного Жителя США) (Unmarried and under 21 years of age) (Legal Permanent Residents (LPR) and American Citizens should not be included) - переход на следующий уровень, где поданы результаты Вашего опроса, если у Вас нет детей, если есть - будет ещё одна форма с анкетой на детей и жену. DS-5501 PAPERWORK REDUCTION ACT *Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, D.C. 20520. Copyright Information 02.00.04