官方表：DS-160 Online Nonimmigrant Visa Application（在线表单，按官方分区填写） ｜ 表内语言：英文（所有字段以拉丁字母填写） ｜ 官方来源：travel.state.gov DS-160 官方说明页；分区名与字段名按 CEAC 在线表分区（本机网络打不开官方 DS-160 示例 PDF，字段名未逐字回原文核对，已在表内标注）
| 申请人 | 王芳 WANG FANG | 目的国 | 美国 UNITED STATES |
| 签证类型 | B1/B2 商务／旅游 | 建单号 | V2026-003 |
| 预填日期 | 2026-10-27 | 预填人 | 环境国际旅行社有限公司天津分公司·签证部 |
| 出行日期 | 2027-01-15 至 2027-01-28（14 天，面签后定） | 递交渠道 | 在线提交 CEAC → 打印带条码确认页 → 自行预约面签 |
| 客户提供（材料出处） | 表内第 X 项要求 | 预填内容 |
|---|---|---|
| 护照资料页 | Personal Information 1 › Surnames | WANG |
| 护照资料页 | Personal Information 1 › Given Names | FANG |
| 身份证／户口本 | Personal Information 1 › Full Name in Native Alphabet | 王芳 |
| 报名表·身份屏 | Personal Information 1 › Have you ever used other names? | [X] No |
| — | Personal Information 1 › Do you have a telecode that represents your name?（中文电码） | 待补 — 需查标准中文电码表：「王」「芳」两字各 4 位数字，本机无法从官方源核到，未估算 |
| 身份证（性别位） | Personal Information 1 › Sex | FEMALE |
| 户口本／结婚证 | Personal Information 1 › Marital Status | MARRIED |
| 护照资料页 | Personal Information 1 › Date of Birth（日-月缩写-年） | 15-AUG-1987 |
| 户口本／身份证 | Personal Information 1 › Place of Birth（City / State/Province / Country） | TANGSHAN / HEBEI / CHINA |
| 护照资料页 | Personal Information 2 › Country/Region of Origin (Nationality) | CHINA |
| 报名表·身份屏 | Personal Information 2 › Do you hold or have you held any nationality other than the one indicated? | [X] No |
| 身份证正面 | Personal Information 2 › National Identification Number | 130203198708150027 |
| — | Personal Information 2 › U.S. Social Security Number | DOES NOT APPLY |
| — | Personal Information 2 › U.S. Taxpayer ID Number | DOES NOT APPLY |
| 报名表·居留屏 | Personal Information 2 › Are you a permanent resident of another country? | [X] No |
| 报名表·联系屏；户口本 | Address and Phone › Home Address | ROOM 501, BUILDING 12, NO. 66 JIANSHE ROAD, LUBEI DISTRICT, TANGSHAN, HEBEI 063000, CHINA |
| 报名表·联系屏 | Address and Phone › Mailing Address | SAME AS HOME ADDRESS |
| 报名表·联系屏 | Address and Phone › Primary Phone Number | +86 136 2000 3333 |
| 在职证明（单位电话） | Address and Phone › Secondary / Work Phone Number | +86 315 2223 456 |
| 报名表·联系屏 | Address and Phone › Email Address | WANGFANG1987@EXAMPLE.COM |
| 报名表·社交屏 | Address and Phone › Social Media（平台＋账号名，近五年用过的全部） | [X] Yes WECHAT / WANGFANG_1987（示例；其余平台如有须全列） |
| 护照资料页（类型栏） | Passport › Passport/Travel Document Type | REGULAR |
| 护照资料页 | Passport › Passport/Travel Document Number | E55667788 |
| 护照资料页（本式护照） | Passport › Passport Book Number | DOES NOT APPLY（电子普通护照无本号） |
| 护照资料页（签发机关） | Passport › Where Was the Passport/Travel Document Issued? | HEBEI PROVINCE PUBLIC SECURITY BUREAU, EXIT-ENTRY ADMINISTRATION |
| 护照资料页 | Passport › Issuance Date／Expiration Date | 20-JUN-2022 ／ 19-JUN-2032 |
| — | Passport › Have you ever lost a passport or had one stolen? | [X] No |
| 行程单／邀请函 | Travel › Purpose of Trip to the U.S. | TEMP. BUSINESS PLEASURE VISITOR (B) |
| 行程单／邀请函 | Travel › Specify | BUSINESS & TOURISM (TEMPORARY VISITOR) (B1/B2) |
| 行程单 | Travel › Have you made specific travel plans? | [X] Yes |
| 行程单／机票 | Travel › Intended Date of Arrival／Intended Length of Stay | 15-JAN-2027 ／ 14 DAYS |
| 酒店确认单 | Travel › Address Where You Will Stay in the U.S. | MIDTOWN MANHATTAN HOTEL, 350 WEST 40TH STREET, NEW YORK, NY 10018, USA |
| 在职证明／流水 | Travel › Person/Entity Paying for Your Trip | SELF |
| 行程单 | Travel Companions › Persons Traveling with You | [X] No （同行人须列姓名与关系） |
| 行程单 | Travel Companions › Are you traveling as part of a group or organization? | [X] No |
| 护照签证页 | Previous U.S. Travel › Have you ever been in the U.S.? | [X] No |
| 护照签证页 | Previous U.S. Travel › Have you ever been issued a U.S. Visa? | [X] No |
| 报名表·风险屏 | Previous U.S. Travel › Have you ever been refused a U.S. visa, or been refused admission? | [X] No |
| — | Previous U.S. Travel › Has anyone ever filed an immigrant petition on your behalf? | [X] No |
| 邀请函（美方联系人） | U.S. Point of Contact › Contact Person / Organization；Relationship；Address；Phone；Email | MS. EMILY CHEN, SALES DIRECTOR EAST COAST IMPORT PARTNERS LLC 350 FIFTH AVENUE, SUITE 1200, NEW YORK, NY 10118 TEL +1 212 555 0134 E.CHEN@EXAMPLE-IMPORT.COM RELATIONSHIP: BUSINESS ASSOCIATE |
| 户口本（父母页） | Family Information › Relatives › Father's Full Name / Date of Birth / In the U.S.? | WANG JIANGUO / 12-MAR-1960 / [X] No |
| 户口本（父母页） | Family Information › Relatives › Mother's Full Name / Date of Birth / In the U.S.? | LIU XIULAN / 05-NOV-1962 / [X] No |
| 报名表·家庭屏 | Family Information › Relatives › Do you have any immediate relatives in the U.S.? | [X] No |
| 结婚证 | Family Information › Spouse › Full Name / Date of Birth / Nationality / Address | SUN TAO / 22-SEP-1985 / CHINA / SAME AS HOME ADDRESS |
| 在职证明 | Present Work/Education/Training › Primary Occupation | BUSINESS |
| 营业执照＋在职证明 | Present Work › Present Employer（名称／地址／电话／入职年月／月收入／职责） | TANGSHAN HENGDA IMPORT & EXPORT CO., LTD. NO. 99 NORTH XINHUA ROAD, LUBEI DISTRICT, TANGSHAN, HEBEI TEL +86 315 2223 456 START DATE 03-2016 MONTHLY INCOME CNY 18,000 DUTIES: OVERSEAS PURCHASING |
| 毕业证 | Previous Work/Education/Training › Education（学校／地址／专业／起止） | HEBEI UNIVERSITY OF TECHNOLOGY NO. 5340 XIPING ROAD, HONGTIAN DISTRICT, TIANJIN / INTERNATIONAL TRADE / 2005–2009 |
| 报名表·风险屏 | Security and Background Part 1–5（传染病／精神障碍／吸毒／犯罪／毒品／卖淫／洗钱／人口贩运／恐怖活动／间谍／种族灭绝／酷刑／器官移植／遣返听证／欺诈／逾期停留／非法投票等） | 全部 [X] No （任一 Yes 须在下方填写说明，且面签时须带证明文件） |
| — | Certification / Signature（提交页电子签名） | 提交时在 CEAC 输入护照号完成电子签名（等同签字）；DS-160 无纸面签名栏。本表签字行为客户核对确认用 |
以上信息由申请人核对确认，与事实一致。申请人签字： 日期：