ELECTRONIC DIVERSITY VISA ENTRY FORM

Approved OMB 1405-0153
Expires: 03/31/2004
Estimated Burden: 30 minutes

Part Two - Dependents  
Druha cast - Manzel/ka a deti

13. Spouse - Manzel/ka

Name Meno

13a. Last/Family  
Priezvisko

13b. First Name  
Meno

13c. Middle Name
"stredne" meno

13d. Date of Birth - Datum narodenia

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 Den

Select Month... 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Mesiac

Select Year... 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 1892 1891 1890 1889 1888 1887 1886 1885 1884 1883 1882 1881 1880 1879 1878 1877 1876 1875 1874 1873 1872 1871 1870 Rok

13e. Gender - pohlavie

Male Muz

Female Zena

13f. City/Town of Birth - Mesto/Dedina Narodenia

Birth City/Town Unknown - Dajte fajku ak neviete  

13g. Country of Birth - Stat v ktorom sa manzel/ka narodila

Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China, People's Republic Of China-Taiwan Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of The Congo, Republic of The Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Special Administrative Region Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Special Administrative Region Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue North Korea Northern Ireland Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

13h. Spouse Photograph - Fotka Manzela/ky
A digital photograph (image) must be submitted for each person listed on an Application. This image must be in the Joint Photographic Experts Group (JPEG) File Interchange Format (JFIF) format. If the image is created by using a digital camera, it must have a resolution of 320 by 240 pixels, with either 24-bits of color, 8-bits of color or 8-bits of gray. If the image is created by scanning a photographic print the original print must have been 2" by 2" (50mm x 50mm), and the scan must be performed at a resolution of 150 dots per inch (dpi); the image must have a resolution of 300 by 300 pixels, with either 24-bits of color, 8-bits of color or 8-bits of gray. The image can not exceed 62,500 bytes (62.5KB) in size. Monochrome images (2-bits of color) will not be accepted. Please refer to the DV2005 Instructions for the pose and background requirements for all photographs.

Photograph File Name - Kliknite na Browse a najdite fotku na vasom pocitaci.  Skontrolujte si fotku predtym ako zacnete vyplnat prihlasku na: http://www.dvlottery.state.gov/photo.php

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.

14. Child #1 - Dieta (prve)

Name Meno

14a. Last/Family  
Priezvisko

14b. First Name  
Meno

14c. Middle Name  
"stredne" meno

14d. Date of Birth - Datum Narodenia Dietata

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 Den

Select Month... 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Mesiac

Select Year... 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 1892 1891 1890 1889 1888 1887 1886 1885 1884 1883 1882 1881 1880 1879 1878 1877 1876 1875 1874 1873 1872 1871 1870 Rok

14e. Gender - Pohlavie Dietata

Male Muz

Female Zena

14f. City/Town of Birth - Mesto/dedina narodenia dietata

Birth City/Town Unknown Dajte fajku ak neviete

14g. Country of Birth - Stat narodenia

Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China, People's Republic Of China-Taiwan Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of The Congo, Republic of The Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Special Administrative Region Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Special Administrative Region Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue North Korea Northern Ireland Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

14h. Child #1 Photograph - Fotka Dietata
A digital photograph (image) must be submitted for each person listed on an Application. This image must be in the Joint Photographic Experts Group (JPEG) File Interchange Format (JFIF) format. If the image is created by using a digital camera, it must have a resolution of 320 by 240 pixels, with either 24-bits of color, 8-bits of color or 8-bits of gray. If the image is created by scanning a photographic print the original print must have been 2" by 2" (50mm x 50mm), and the scan must be performed at a resolution of 150 dots per inch (dpi); the image must have a resolution of 300 by 300 pixels, with either 24-bits of color, 8-bits of color or 8-bits of gray. The image can not exceed 62,500 bytes (62.5KB) in size. Monochrome images (2-bits of color) will not be accepted. Please refer to the DV2005 Instructions for the pose and background requirements for all photographs.

Photograph File Name Kliknite na Browse a najdite fotku dietata na vasom pocitaci.  Skontrolujte si fotku predtym ako zacnete vyplnat prihlasku na: http://www.dvlottery.state.gov/photo.php

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.