Voici les infos que vous aurez besoin pour remplir votre lors de votre enregistrement pour la lotterie du gouvernement americain qui octroie la residence permananete aux gagnants. N.B Avant de de passer a cette etape,assurez vous que votre photo format passeport est valide en verifiant sur le site par telechargement de celle-ci. U.S. Department of State Banner Applicant Entry Systemv11.00.00 Online Help ELECTRONIC DIVERSITY VISA ENTRY FORM OMB Control Number: 1405-0153 Form: DS-5501 Expires: 08/31/2016 Estimated Burden: 30 minutes Part One - Entrant Information 1. Name a. Last/Family Name No Last/Family Name b. First Name No First Name c. Middle Name No Middle Name 2. Birth Date a. Day Select Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 b. Month Select Month... January February March April May June July August September October November December c. Year 3. Gender Male Male Female Female 4. City Where You Were Born (Enter Birth City Only. Do not enter District/County/Province/State) Birth City Unknown 5. Country Where You Were Born Select A Country... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Baker Island Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China, Peoples Republic Of Christmas Island Cocos Keeling Islands Colombia Comoros Congo-Brazzaville Congo-Kinshasa Cook Islands Costa Rica Cote dIvoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia, Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gaza Strip Georgia Germany Ghana Gibraltar Great Britain and Northern Ireland Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Special Administrative Region Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Johnston Atoll Jordan Kazakhstan Kenya Kiribati Korea, North Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Special Administrative Region Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue No Mariana Islands (USA) Norfolk Island Northern Ireland Norway Oman Pakistan Palmyra Atoll Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic Of Palau Republic Of The Marshall Islands Reunion Romania Russia Rwanda Saint Martin Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Island South Korea South Sudan Spain Sri Lanka St. Barthelemy St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States Of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (U.S.) Wake Island Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe 6. Country of Eligibility for the DV Program Your country of eligibility will normally be the same as your country of birth. Your country of eligibility is NOT related to where you live. If you were born in a country that is not eligible for the DV program, please go to Explanation of Country of Eligibility {this link will open in a new window} to see if there is another option available in your case. Are you claiming eligibility based on the country where you were born? Yes No If not, you must enter the country from which you are claiming eligibility. Select A Country... Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Cape Verde Central African Republic Chad Chile Christmas Island Cocos Keeling Islands Comoros Congo-Brazzaville Congo-Kinshasa Cook Islands Costa Rica Cote dIvoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Egypt Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Federated States of Micronesia, Fiji Finland France French Polynesia French Southern and Antarctic Lands Gabon Georgia Germany Ghana Greece Greenland Grenada Guatemala Guinea Guinea-Bissau Guyana Honduras Hong Kong Special Administrative Region Hungary Iceland Indonesia Iran Iraq Ireland Israel Italy Japan Jordan Kazakhstan Kenya Kiribati Korea, North Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Special Administrative Region Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Mauritania Mauritius Mayotte Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Niue Norfolk Island Northern Ireland Norway Oman Panama Papua New Guinea Paraguay Poland Portugal Qatar Republic Of Palau Republic Of The Marshall Islands Romania Russia Rwanda Saint Martin Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka St. Barthelemy St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 7. Entrant Photograph Photographs must be submitted at the time of eDV entry. Photographs that do not comply with all specifications, including but not limited to recency of the photos, composition of the photos, and unacceptable backgrounds are grounds for disqualification of the entire entry. Any manipulation of photographs that alters the facial characteristics is grounds for disqualification of the entire entry. See examples on the Photo Validation {this link will open in a new window} page. Please refer to the Instructions for the 2015 Diversity Immigrant Visa program (DV-2015) 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. Link to photo instructions/photo validation page {this link will open in a new window} Photograph File Name 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 above. 8. Mailing Address 8a. In Care Of (optional) 8b. Address Line 1 8c. Address Line 2 (optional) 8d. City/Town 8e. District/County/Province/State 8f. Postal Code/Zip Code No Postal Code/Zip Code 8g. Country Select A Country... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Baker Island Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China, Peoples Republic Of Christmas Island Cocos Keeling Islands Colombia Comoros Congo-Brazzaville Congo-Kinshasa Cook Islands Costa Rica Cote dIvoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia, Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gaza Strip Georgia Germany Ghana Gibraltar Great Britain and Northern Ireland Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Special Administrative Region Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Johnston Atoll Jordan Kazakhstan Kenya Kiribati Korea, North Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Special Administrative Region Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue No Mariana Islands (USA) Norfolk Island Northern Ireland Norway Oman Pakistan Palmyra Atoll Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic Of Palau Republic Of The Marshall Islands Reunion Romania Russia Rwanda Saint Martin Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Island South Korea South Sudan Spain Sri Lanka St. Barthelemy St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States Of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (U.S.) Wake Island Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe (NOTE: This is the address that will be used to notify you if you are selected.) 9. Country Where You Live Today Select A Country... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Baker Island Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China, Peoples Republic Of Christmas Island Cocos Keeling Islands Colombia Comoros Congo-Brazzaville Congo-Kinshasa Cook Islands Costa Rica Cote dIvoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia, Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gaza Strip Georgia Germany Ghana Gibraltar Great Britain and Northern Ireland Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Special Administrative Region Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Johnston Atoll Jordan Kazakhstan Kenya Kiribati Korea, North Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Special Administrative Region Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue No Mariana Islands (USA) Norfolk Island Northern Ireland Norway Oman Pakistan Palmyra Atoll Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic Of Palau Republic Of The Marshall Islands Reunion Romania Russia Rwanda Saint Martin Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Island South Korea South Sudan Spain Sri Lanka St. Barthelemy St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States Of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (U.S.) Wake Island Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe 10. Phone Number (optional) 11. E-mail Address 11a. E-Mail Address (e.g. johndoe@example) 11b. Confirm E-Mail Address 12. What is the highest level of education you have achieved, as of today? Primary school only University Degree High School, no degree Some Graduate Level Courses High School degree Masters Degree Vocational School Some Doctorate Level Courses Some University Courses Doctorate Degree You must have a minimum of a high school diploma reflecting the completion of a full course of study (vocation schools or equivalency degrees are not acceptable) or be a skilled worker in an occupation that requires at least two years of training or experience to qualify (visit online.onetcenter.org/ {this link will open in a new window} to see if your occupation qualifies) for a Diversity Visa. 13. What is your current marital status? Unmarried Married Divorced Widowed Legally Separated Legal separation means that a court has formally declared that you and your spouse are legally separated. Legal separation means that your spouse would not be eligible to immigrate as your derivative. 14. Number of Children (optional) Children include all biological children, legally adopted children, and stepchildren who are unmarried and under the age of 21 on the date that you submit your entry. Failure to include all children or inclusion of children who are not your biological children, legally adopted children, and stepchildren (regardless of whether they live with you and/or intend to apply for a visa as your derivative) is grounds for disqualification of the entire entry. -------------------------------------------------------------------------------- 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 documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: [email protected]. CONFIDENTIALITY STATEMENT: AUTHORITIES: The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. Section 222(f) provides that the records of the Department of State and of diplomatic and consular offices of the United States pertaining to the issuance and refusal of visas or permits to enter the United States shall be considered confidential and shall be used only for the formulation, amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of such records may be made available to a court provided the court certifies that the information contained in such records is needed in a case pending before the court. PURPOSE: The U.S. Department of State uses the facts you provide on this form primarily to determine your classification and eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. Although furnishing this information is voluntary, failure to provide this information may delay or prevent the processing of your case. ROUTINE USES: If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social Security Administration will use the information to issue a social security number. The information provided may also be released to federal agencies for law enforcement, counterterrorism and homeland security purposes; to Congress and courts within their sphere of jurisdiction; and to other federal agencies who may need the information to administer or enforce U.S. laws. usagov Consular Affairs Main Page | Welcome Page | Top of Page This site is managed by the Bureau of Consular Affairs, U.S. Department of State. External links to other Internet sites should not be construed as an endorsement of the views contained therein. 0dff4b49-241f-4068-92c6-6bacf5159bca WC:0dff4b49-241f-4068-92c6-6bacf5159bca
Posted on: Sat, 05 Oct 2013 16:21:04 +0000
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