U.S. Department of State
CONTACT INFORMATION AND WORK HISTORY
FOR NONIMMIGRANT VISA APPLICATION

PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM
PLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS
1. Last name(s) First name(s)
Sereejav Enkhmunkh


2. Date of Birth(mm-dd-yyyy)
05-15-1989
3. Please of Birth Country City/Town state/province
Mongolia Ulaanbaatar

4. Permanent Home Address and Telephone Number (include apartment number, street, city, state or province, postal zone, and country)
Tel:91668779
Chingeltei district, 6th khoroo, apt#02-85, Ulaanbaatar city, Mongolia
5. Full Name and Address of Spouse (if applicable) (postal box number unacceptable)
Name (Last, Fist, Middle): Sereejav Enkhmunkh
Address: Chingeltei district, 6th khoroo, apt#02-85,Ulaanbaatar Mongolia
Telephone Number: 91668779
6. Full Name and Addresses of Children, Parents, Siblings (postal box number unacceptable
Name (Last, Fist, Middle)
Tserenpil Zanaa (Mother)
Sereejav I (Father)
Gangaa Tserenpil (Sister)
Gantulga Tserenpil(Brother)
Ganzul Tserenpil (Sister)
Enkhnaran Tserenpil (Sister)
7. List at Least Two Contacts in Applicant’s Country of Residence Who Can Verify Information About Applicant(do not list immediate family members or other relatives) (postal box number unacceptable)
Name (Last, Fist, Middle)
Sereejav Enkhmunkh
Address:
Chigeltei district, 6th khoroo, Apt#02-85,Ulaanbaatar city, Mongolia
Telephone Number:
91668779




Paperwork Reduction Act Statement
Public reporting burden for this collection of information is estimated to average 1 hour per response including time required existing data sources, gathering the necessary data providing the information required, and reviewing the final collection. In accordance with 5CFR 1320 5(b), persons are not required to respond to the collection of this information unless this from 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, DC 20520.


I certify that I have read and understood all the questions set forth in this from and the answers I have furnished on this form are true and correct to the best of my knowledge and belief. I understand that any false or misleading statement may result in the permanent refusal of a visa or denial of entry into the United States.

APPLICANT’S SIGNATURE__S.Enkhmunkh_________ DATE(mm-dd-yyyy)_July-15-2007_