Bunny兔和Bear熊

2018/5/31

遞交I-129

2018/6/4

NOA (Receipt)

2018/11/20

NOA (Approval)

2018/12/26

NCV Notice

2019/1/3

K E-Packet 3 letter

2019/1/16

體檢

2019/2/16

預約面試時間

2019/3/14

AIT面試

2019/3/22

收到K1 visa

2019/5/27

入境美國

Personal information

個人資訊

Surnames

姓氏（同護照的英文）

Given Names

名字（同護照的英文，去掉”-“，可輸入空格或是連在一起，例如：Hue-Mei，應改為Hue Mei或Huemei）

Full Name In Native Language:

用中文寫全名

Have you ever used other names

您的證件上是否曾經使用過其他的名字

Do you have a telecode that represents your name

是否有電碼來代表您的名字

Sex: Male/ Female

性別：男性/女性

Marital Status:

Married

Common Law Marriage

Civil Union/Domestic Partnership

Single

Widowed

Divorced

Legally Separated

Other

婚姻狀態(請擇一)：

已婚

普通法婚姻

合法註冊/同居伴侶關係

單身

喪偶

離婚

合法分居

其他

Date of Birth:

Place of Birth:

Country/Region of Birth

出生日期

出生地點 

出生國家

Country/Region of Origin (Nationality)

國籍 

Do you hold or have you held any nationality other than the one Indicated above on nationality ?

您是否擁有其他國家的國籍？

Are you a permanent resident of a country/region other than your country/region of origin (nationality) above?

除了上述國籍外，您是否擁有其他國家的居留證？

National Identification Number

台灣的身份證號碼

U.S. Social Security Number

美國的社會安全號碼，沒有的話請勾選Does not apply

U.S. Taxpayer ID Number

美國的稅籍號碼(免填)

Address and phone information

住址和電話

Home Address

住家地址

(地址中英譯參考網站，請點此)

City

城市

State/Province: Postal Zone/ZIP Code

州/省分/郵遞區號

(台灣的地址勾選Does not apply)

Country/Region

國家/區域

Is your Mailing Address the same as your home address?

Mailing Address：若欲寄送美簽之護照的地址不同於上述地址時，需勾選No，然後填寫寄送地址

Primary Phone Number

Secondary Phone Number

Work Phone Number

Email Address

主要連絡電話(填寫最常用的號碼)

次要連絡電話

辦公室連絡電話

電子郵件信箱

Passport/Travel Document Type

Regular

Official

Diplomatic

Other

持有的護照/旅行證件種類(請擇一)

普通

公務

外交

其他

Passport/Travel Document Number

持有的護照/旅行證件號碼

Passport Book Number

台灣護照勾選Does Not Apply 

Country/Authority that Issued Passport/Travel Document

哪個國家/機關發出您所持有的護照/旅行證件

City Where Issued

Country/Region Where Issued:

發放的城市

發放的國家/區域

Issuance Date

發照日期 

Expiration Date

有效日期

（申請面試時，護照的有效期限需要六個月以上） 

Have you ever lost a passport or had one stolen?

您的護照是否曾經遺失或被偷？

(若勾選是的話需要解釋事發經過)

Travel Information

旅遊資訊

Have you made specific travel plan?

您是否擬定特定旅遊計劃了呢?

Purpose of Trip to the U.S.

訪美目的

Specify

簽證種類

Application Receipt/Petition Number

申請書/收據的號碼

Intended Date of Arrival

預計何時前往美國

Address where you will stay in the U.S.

住在美國的地址

City, State, Postal/Zip Code

城市，州，郵遞區號

Person/Entity Paying for Your Trip

支付您旅遊費用的個人或機構名稱

Are there other persons traveling with you?

是否有其他人和您一起訪美呢?

Are you traveling as part of a group or organization?

您是否和團體或機構一同旅遊?

Persons Traveling with You:

和您旅遊的人

Name

姓名

Relationship to you

和您的關係

Have you ever been in the U.S.?

您是否曾經到美國?

Date Arrived

抵達日期

Length of Stay

待在美國幾天

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

您現在或過去是否持有美國駕照呢?

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

您是否曾經申請美國簽證?

Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?

您是否曾經被拒簽、拒絕入境美國、或被海關原機遣返呢?

Has anyone ever field an Immigrant petition on your behalf with the United States Citizenship and Immigration Services?

是否曾有人代替您填寫移民申請書寄送給美國移民局呢?

U.S. Contact Information

美國聯絡資訊

Contact Person Name In the U.S.

在美聯絡人

Organization Name In the U.S.

在美聯絡機構

Relationship to you

和您的關係

Family Information

家庭資訊

Father's Surnames

父親的姓

Father's Given Names

父親的名

Father's Date of Birth:

父親的生日

Is your father still living?

您的父親是否健在?

Father's Address

父親的地址

City

城市

State/Province:

州/省分

(若是台灣的地址勾選Does not apply)

Postal Zone/ZIP Code

郵遞區號

Country/Region

國家/區域

Is your father in the U.S.?

您的父親是否住在美國?

Mother's Surnames

母親的姓

Mother's Given Names

母親的名

Mother's Date of Birth

母親的生日

Is your mother still living?

您的母親是否健在?

Mother's Address

母親的地址

City

城市

State/Province

州/省分

(若是台灣的地址勾選Does not apply)

Postal Zone/ZIP Code

郵遞區號

Country/Region

國家/區域

Is your mother in the U.S.?

您的母親是否住在美國?

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

您是否有任何直系血親住在美國(不包含父母)?

Do you have any other relatives in the United States?

您是否有其他親戚住在美國?

Flancé/Flancée's Full Name

未婚妻/未婚夫的全名

Flancé/Flancée's Date of Birth

未婚妻/未婚夫的生日

Flancé/Flancée's Address

未婚妻/未婚夫的地址

City

城市

State/Province

州/省分

Postal Zone/ZIP Code

郵遞區號

Flancé/Flancée's Occupation

未婚妻/未婚夫的職業

Do you have any former spouses?

您是否再婚?

Do you have any children?

您是否有小孩?

Work/Education/Training Information (1)

工作/教育/受訓資訊 (1)

Primary Occupation:

Agriculture

Artist/Performer

Business

Communications

Computer Science

Culinary/Food Services

Education

Engineering

Government

Homemaker

Legal Profession

Medical/Health

Military

Natural Science

Not Employed

Physical Sciences

Religious Vocation

Research

Retired

Social Science

Student

Other

主要職業(請擇一)：

農業

藝術家/演出家

商業

傳播通信

電腦科學

烹飪/食品服務

教育

工程

政府

家庭主婦

法律行業

醫療/健康

軍事

自然科學

無工作(待業)

物理科學

宗教職業

研究

退休

社會科學

學生

其他

Explain

解釋(工作內容、待業原因...等等)

Work/Education/Training Information (2)

工作/教育/受訓資訊 (2)

Were you previously employed?

您以前是否有工作經驗

Employer Name

公司名稱

Employer address

公司地址

City

城市

State/Province

州/省分

Postal Zone/ZIP Code

郵遞區號

Country/Region

國家/區域

Telephone Number

電話號碼

Job Title

職稱

Supervisor's Surname

主管的姓

Supervisor's Given Name

主管的名

Employment Date From

就職日期

Employment Date To

離職日期

Briefly describe your duties

簡述您的工作內容

Work/Education/Training Information (3)

工作/教育/受訓資訊  (3)

Have you attended any educational Institutions at a secondary level or above?

您是否受過國中或更高的教育?

(可選Add Another來增加學歷喔)

Name of Institution

學校名稱

Address of Institution

學校電話

City

城市

State/Province

州/省分

Postal Zone/ZIP Code

郵遞區號

Country/Region

國家/區域

Course of Study

主修

Date of Attendance From

修課開學日

Date of Attendance To

學課畢業日

Provide a list of Languages You Speak

請寫出您可流利使用的語言

Language Name

語言名稱

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

在過去五年，您是否有到其他國家/區域旅遊呢?

Provide a list of Countries/Regions Visited

請寫出您參訪過的國家/區域

Security and Background Information (1)

安全和背景資訊 (1)

(這裡的問題是關於恐怖組織、犯罪和健康等方面，原則上全部選No)

Do you belong to a clan or tribe?

您是否隸屬於幫派或組織?

Have you resided In any country/region for six months or longer since you attained 16 years of age?

您從16歲後是否曾在任何國家/地區居住過六個月或更長時間嗎？

Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?

您是否貢獻於任何專業、社交或慈善組織？

Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?

您是否擁有槍支、爆炸物、核能、生物或化學經驗的專業技能？

Have you ever served in the military?

您是否曾在軍中服役？

Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or Insurgent organization?

您是否曾參與準軍事部隊、治安警察部隊、反叛組織、游擊組織或叛亂組織，並成為成員？

Do you have a communicable disease of public health significance? (Communicable diseases of public significance 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.)

您是否患有具有公共衛生關注性的傳染病？（具有公共關注性的傳染病包括軟性下疳，淋病，腹股溝肉芽腫，傳染性麻風病，性病淋巴肉芽腫，傳染性梅毒，活耀性肺結核和其他由衛生及公共服務部指定的疾病。）

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?

您是否患有精神或身體疾病，可能威脅到您自己或他人的安全或福祉？

Security and Background Information(2)

安全和背景資訊(2)

Are you or have you ever been a drug abuser or addict?

您過去或現在是否為毒品濫用成癮者呢？

Do you have documentation to establish that you have received vaccinations in accordance with U.S. law?

您是否有文件證明您已經按照美國法律接種了疫苗？

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action?

您是否曾因犯罪而被捕，即使遭到特赦或其他類似判決？

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?

您是否曾經違反或密謀任何與管控物質有關的法律？

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years?

您是否將在美國從事賣淫或非法販賣人口，或您是否在過去10年內來美國從事賣淫或拉皮條？

Have you ever been Involved in, or do you seek to engage in, money laundering?

您是否曾經參與或試圖從事洗錢？

Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?

您是否曾經在美國或美國以外地區從事或密謀販賣人口罪？

Are you the spouse, son, or daughter of an Individual who has committed or conspired to commit a human 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?

在美國或美國境外，您是否為販賣人口罪犯的配偶或兒女？並且在過去五年內，您是否從此罪中圖利？

Security and Background Information(3)

安全和背景資訊(3)

Have you knowingly aided, abetted, assisted or colluded with an Individual who has committed or conspired to commit a severe human trafficking offense In the United States or outside the United States?

在美國或美國境外，您是否有意協助或串通人口走私罪行的重大罪犯？

Are you the spouse, son, or daughter of an Individual who has been identified by the President of the United States as person who plays a significant role in a severe form in trafficking In persons and have you, within last five years, knowingly benefited from the trafficking activities?

您的家人是否被美國總統認定為人口販運的重大罪犯？您是他的配偶還是兒女？並且在過去五年內，您是否從此罪中圖利？

Are you the spouse, son, or daughter of an Individual who has violated any controlled substance trafficking law, and have knowingly benefited from the trafficking activities in the past five years?

您的家人是否違反了任何管製藥物的販運法律？您是他的配偶還是兒女？並且在過去五年內，您是否從此罪中圖利？

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?

您是否打算在美國當間諜、蓄意破壞、違反出口管制或任何其他非法行為？

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?

您是否打算在美國從事恐怖活動，您曾經從事過恐怖活動嗎？

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?

您是否曾經或現在打算向恐怖組織提供財務或其他支持？

Are you a member or representative of a terrorist organization?

您是恐怖組織的成員或代表嗎？

Security and Background Information(4)

安全和背景資訊(4)

Have you ever ordered, incited, committed, assisted, or otherwise participated In genocide?

您是否曾經下令、煽動和協助執行種族滅絕？

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?

您是否曾經下令、煽動和協助執行酷刑？

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?

您是否曾經下令、煽動和協助執行非法處決，政治謀殺或其他暴力行為？

Have you ever engaged in the recruitment or the use of the child soldiers?

您是否曾經招募或雇用童工？

Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?

當您任職政府官員時，是否曾直接負責或實施強烈剝奪他人的宗教自由？

Are you a member of or affiliated with the Communist or other totalitarian party?

您是共產黨或其他極權政黨的成員嗎？

Have you ever directly or indirectly assisted or supported any of the groups In Colombia known as the Revolutionary Armed Forces of Colombia (FARC), National Liberation Army (ELN), or United Self-Defense Forces of Colombia (AUC)?

您是否曾經直接或間接地協助或支持哥倫比亞的任何組織？（這些組織被稱為哥倫比亞革命武裝部隊(FARC)，民族解放軍(ELN)或哥倫比亞聯合自衛隊(AUC)）

Have you ever through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation to which a United States national had claim of ownership?

您是否曾經在美國擁有統治權的國家中，因政府濫用政治立場以謀取私利、或沒收您財產的虐待？

Security and Background Information(5)

安全和背景資訊  (5)

Are you the spouse, minor child, or agent of an Individual who has through abuse of governmental or political position converted for personal gain, confiscated or expropriated property In a foreign nation to which a United States national had claim of ownership?

您的配偶，未成年子女或代理人，是否曾在美國擁有統治權的國家中，因濫用政府或政治的職位去謀取個人利益，而被沒收財產？

Have you ever disclosed or trafficked In confidential U.S. business Information obtained in connection with U.S. participation In the Chemical Weapons Convention?

您是否曾經洩漏或出賣過關於美國化學武器協約的機密企業訊息？

Are you the spouse, minor child, or agent of who has disclosed or trafficked In confidential U.S. business Information obtained in connection with U.S. participation in the Chemical Weapons Convention?

您的配偶，未成年子女或代理人，是否曾經洩漏或出賣過關於美國化學武器協約的機密企業訊息？

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free will?

您是否曾經直接涉入或執行人口數量控制，意即即使對方沒有同意，仍強迫婦女流產，或強制男女絕育？

Have you ever been directly Involved in the coercive transplantation of human organs or bodily tissue?

您是否曾經直接參與人體器官或身體組織的非法移植？

Have you ever been the subject of a removal or deportation hearing?

您是否曾經被遣返或驅逐出境？

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States Immigration benefit by fraud or willful misrepresentation or other unlawful means?

您是否曾經為了進入美國或取得美國移民福利，試圖通過欺詐、蓄意捏造陳述或其他非法手段來讓自己或他人獲得簽證？

Security and Background Information(6)

安全和背景資訊(6)

Have you failed to attend a hearing on removability or Inadmissibility within the last five years?

在過去五年中，您是否未出席關於驅逐出境或拒絕入境的聽證會？

Have you ever been unlawfully present, overstayed the amount of time granted by an Immigration official or otherwise violated the terms of a U.S. Visa?

您是否曾經非法停留在美國，意即入境後超過了移民局所核准的時日，或者是否曾以不同形式違反了美國簽證條款？

Are you subject to a civil penalty under INA 247C?

您是否會受到INA 247C的民事懲處？

Have you been ordered removed from the U.S. during the last five years?

在過去五年中，您是否從美國被驅逐出境？

Have you been ordered removed from the U.S. for a second time within the last 20 years?

在過去的20年中，您是否曾兩度從美國被遣返？

Have you ever been unlawfully present and ordered removed from the U.S. during the last ten years?

在過去十年中，您是否曾經非法居留在美國，且從美國被驅逐出境？

Have you ever been convicted of an aggravated felony and been ordered removed from the U.S.?

您是否曾因被判重罪而被下令從美國驅逐出境？

Have you ever been unlawfully present in the U.S. for more than 180 days (but no more than one year) and have voluntarily departed the U.S. within the last three years?

您是否曾經在美國非法居留超過180天（但不超過一年），並且在過去三年內自動出境美國？

Have you ever been unlawfully present in the U.S. for more than one year in the aggregate at any time during the past ten years?

在過去十年中，您是否曾在美國非法居留超過一年？

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. court?

您是否曾經在美國境外對擁有監護權的美國公民中止其探視權?

Have you voted in the United States in violation of any law or regulation?

您在美國投票時是否違反了任何法律規定？

Security and Background Information(7)

安全和背景資訊(7)

Have you ever renounced United States citizenship for the purpose of avoiding taxation?

您是否曾經為了逃稅而放棄美國國籍？

Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement?

您以前是否為交流訪問學者（J簽證），且兩年的外國居住要求尚未期滿？

Have you attended a public elementary school on student (F) status or a public secondary school after November 30, 1996 without reimbursing the school?

您是否在1996年11月30日之後使用學生身份（F簽證）免費就讀公立小學或公立中學？

Do you seek to enter the United States for purpose of performing skilled or unskilled labor but have not yet been certified by the Secretary of Labor?

您是否打算以技術或非技術勞動身分進入美國，但尚未獲得勞工部長的認證？

Are you a graduate of a foreign medical school seeking to perform medical services in the United States but have not yet passed the National Board of Medical Examiners examination or its equivalent?

您是否為外國醫學院的畢業生，且正在找美國醫療相關服務的工作，但尚未通過國家醫療審查會的考試或學歷認證？

Are you a health care worker seeking to perform such work in the United States but have not yet received certification on Graduates of Foreign Nursing Schools or from an equivalent approved Independent credentialing organization?

您是否為醫療人員，且打算在美國從事相關工作，但尚未收到外國護理學院畢業書的認證或是學歷還未被獨立認證機構核准？

Are you permanently Ineligible for U.S. citizenship?

您是否永久失去申請美國公民的資格？

Have you ever departed the United States In order to evade military service during a time of war?

您是否曾經在戰爭時期為了逃避兵役而離開美國？

Are you coming to the U.S. to practice polygamy?

您要來美國從事一夫多妻制嗎？

Has the Secretary of Homeland Security of the United States ever determined that you knowingly made a frivolous application for asylum?

美國國安部長是否曾經判定您蓄意提出了不實的庇護申請？

Location Information

地點資訊

Location where you will be submitting your application

您將於何處遞交此份申請書

Current Location

目前位址

Preparer of Application

填寫申請書

Did anyone assist you in filling out this application?

是否有人幫你填申請書？

*如果是的話，請填寫對方的姓名、公司及地址…等資料