1. SURNAME - Your last name.
2. FULL NAME - Your first and middle names.
3. OTHER NAMES OR SURNAMES USED IN THE PAST - Your maiden or birth name, if changed.
4. DATE OF BIRTH - Day/Month/Year.
5. SEX - gender.
6. NATIONALITY - USA or other country whose passport you carry.
7. PERSONAL NUMBER - Your social security number.
8. ADDRESS OF PERMANENT RESIDENCE - your address for the FEDEX delivery.
9. PASSPORT DETAILS /type - please indicate letter above your name (usually, it is P), unless it is DIPLOMATIC.
Number - passport number.
Date of Issues - Day/Month/Year; Valid until - Day/Month/Year
Issuing Authority - Passport Agency by which city (if indicated in passport).
10. through 14: Please answer these questions.
15. PURPOSE OF YOUR JOURNEY - please indicate TOURISM, unless you have a personal or business invitation. In this case, indicate PRIVATE.
16. DURATION OF STAY IN UKRAINE - please indicate the exact amount of days or months.
17. DATE OF PROPOSED ENTRY TO UKRAINE - Day/Month/Year
18. POINT OF ENTRY TO UKRAINE – The name of the Ukrainian city where you will first enter Ukraine.
19. MEANS OF TRANSPORTATION FOR ENTRY TO UKRAINE - Please indicate air, unless it is train, bus or ship.
20. NAME AND ADDRESS OF PERSON WHO INVITES - Please indicate the name and address of the person in Ukraine.
21. CITIES IN UNRAINE YOU INTEND TO VISIT - Please indicate all the cities on your journey.
22. ADDRESS OF TEMPORARY RESIDENCE IN UKRAINE - Please indicate the Hotel name or the private residence address where you intend to reside during your stay.
23. IN CASE OF NEED WHO WILL GIVE YOU FINANCIAL SUPPORT – enter “I will support myself.”
24. CHILDREN - Please indicate if applies, otherwise leave it blank.
25. IF YOU HAVE BEEN TO UKRAINE, INDICATE THE DATE OF LAST VISIT - Day/Month/Year
26. VISA REQUESTED FOR: Please indicate whether single or double.
27. through 30: Leave it blank because it does not apply.
31. DATE OF PROPOSED DEPARTURE FROM UKRAINE: Day/Month/Year.
32. PLACE of SUBMISSION – Leave this item blank.
