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Type of VISA Diplomatic Official Regular Other A1 A2 A3 G1 G2 G3 G4 Female G5 Specify type Permanent Resident A For A3 G5 Give I-94 Expiration Date mm-dd-yyyy 10. DS-2004 xx-xxxx Enter present nationality. Enter employee s date of birth mm-dd-yyyy. Enter nationality at birth even if the same as Number 4. 1405-0105 EXPIRATION DATE xx-xx-xxxx ESTIMATED BURDEN 20 MINUTES FOR OFFICIAL USE ONLY P R A T PID TO Secretary of State Attention - Office of Protocol 1. From Name of Embassy/Mission 2. Type...
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