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Nonimmigrant Visa

Lost or Stolen Nonimmigrant Visas Form

If your non-immigrant visa is lost or stolen, report it immediately to the local police and then complete the following form.

All fields in this form are required, including the police report number. Please note you must submit a copy of the report electronically along with this form.

For each lost or stolen visa there should be a corresponding form completed.

 
Fields marked with an "*" are required
1. Type of report:
2. * Complete name of visa applicant [name(s), last name(s)]:
3. * Date of birth: (DD/MM/YEAR)
4. * Place of birth:
5. * Telephone:
6. * Email Address:
7. Visa Class: Other:
8. Type Lost or Stolen:
9. * Issuing Post:
10. * Date when visa was lost/stolen: (DD/MM/YEAR)
11. Brief description of how the visa was lost/stolen:
12. Scanned Police Report:
13. Police report case number:
14. Date when the police report was filed (DD/MM/YEAR):
15. City and State where the police report was filed: