D2l2jhoszs7d12 cloudfront stateFederalU S Department of State EXPIRES: 12-31-2019 ESTIMATED BURDEN-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Petitioner's Name in the designated field, ensuring you include Last, First, and Middle names.
3. Next, fill in the Visa Applicant's Name using the same format as above.
4. Provide your email address and phone number in the respective fields for communication purposes.
5. Input your Case Number and Fee Amount Paid to help process your application efficiently.
6. If known, enter the Date(s) of Visa Reissuance(s) to provide additional context for your request.
7. Specify the Refund Check Recipient's name and their address, including Street, City, and State for accurate delivery.
8. Once completed, review all entries for accuracy before submitting the form to the appropriate Consular Section as indicated.

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