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								ELECTRONIC
								DIVERSITY VISA ENTRY FORM 
							 | 
							
								Approved
								OMB 1405-0153 
Expires: 04/30/2007 
Estimated Burden:
								30 minutes 
								 
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												If you need to go back and
												make a correction, DO NOT use the back button on your
												browser. Instead use the appropriate button here or
												below: 
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								Part Two
								- Dependents
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								13.
								Spouse Name
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								a. Last/Family Name 
 
 
 
No
								Last/Family Name 
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								b. First Name 
 
 
 
No
								First Name 
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								c. Middle Name 
 
 
 
No
								Middle Name 
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								13d.
								Birth Date
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								13e.
								Gender
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Male
																 
 
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Female
																 
 
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								13f.
								City Where You Were Born
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Birth
								City/Town Unknown 
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								13g.
								Country Where You Were Born
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								13h.
								Spouse Photograph
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								Photographs that do not comply
								with all specifications, including but not limited to recency
								of the photos, composition of the photos, and unacceptable
								backgrounds are grounds for disqualification of the entire
								entry. Any manipulation of photographs that alters the facial
								characteristics is grounds for disqualification of the entire
								entry. See examples on the Photo
								Validation
								page. 
								
								Please refer to the
								Instructions for the 2008 Diversity Immigrant Visa Program
								(DV-2008) for technical specifications and compositional
								specifications for the digital image. 
								
								You will use one of the
								following methods to enter the image into eDV: 
								 
								
								
								Link
								to photo instructions/photo validation page 
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								Photograph File Name
								 
 
If you
								know the location in the computer and the name of the file
								which is storing the photograph, enter in the box to the left
								of(the) "Browse" button. If you are not sure of the
								location in the computer or the name of the file, clicking
								the "Browse" button will allow you to look for and
								choose the file which is storing the photograph, and after
								you choose the file its name will appear in the box on the
								left. 
								 
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								14.
								Child #1 Name
							 | 
						 
						 
						 
					
					
						
							
								a. Last/Family Name 
 
 
 
No
								Last/Family Name 
							 | 
							
								b. First Name 
 
 
 
No
								First Name 
							 | 
							
								c. Middle Name 
 
 
 
No
								Middle Name 
							 | 
						 
						 
						 
					
					
						
							
								14d.
								Birth Date
							 | 
						 
						 
						 
					
					
						
							| 
							 | 
							
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								14e.
								Gender
							 | 
						 
						 
						 
					
					
						
							
								 
Male
																 
 
							 | 
							
								 
Female
																 
 
							 | 
							
								  
							 | 
						 
						 
						 
					
					
						
							
								14f.
								City Where You Were Born
							 | 
						 
						 
						 
					
					
						
							
								 
 
 
Birth
								City/Town Unknown 
							 | 
						 
						 
						 
					
					
						
							
								14g.
								Country Where You Were Born
							 | 
						 
						 
						 
					
					
						
							| 
							 | 
						 
						 
						 
					
					
						
							
								14h.
								Child Photograph
							 | 
						 
						 
						 
					
					
						
							
								Photographs that do not comply
								with all specifications, including but not limited to recency
								of the photos, composition of the photos, and unacceptable
								backgrounds are grounds for disqualification of the entire
								entry. Any manipulation of photographs that alters the facial
								characteristics is grounds for disqualification of the entire
								entry. See examples on the Photo
								Validation
								page. 
								
								Please refer to the
								Instructions for the 2008 Diversity Immigrant Visa Program
								(DV-2008) for technical specifications and compositional
								specifications for the digital image. 
								
								You will use one of the
								following methods to enter the image into eDV: 
								 
								
								
								Link
								to photo instructions/photo validation page 
							 | 
						 
						 
						 
					
					
						
							
								Photograph File Name
								 
 
If you
								know the location in the computer and the name of the file
								which is storing the photograph, enter in the box to the left
								of(the) "Browse" button. If you are not sure of the
								location in the computer or the name of the file, clicking
								the "Browse" button will allow you to look for and
								choose the file which is storing the photograph, and after
								you choose the file its name will appear in the box on the
								left. 
								 
							 | 
						 
						 
						 
					
					
						
							
								 
 
 
							 | 
						 
					
				 
				
				 
				 
				
					
				
				 
 
				
				PAPERWORK REDUCTION ACT 
 
*Public
				reporting burden for this collection of information is estimated
				to 
average 30 minutes per response, including time required
				for searching 
existing data sources, gathering the necessary
				data, providing the 
information required, and reviewing the
				final collection. In accordance with 
5 CFR 1320 5(b),
				persons are not required to respond to the collection of 
this
				information unless this form displays a currently valid OMB
				control 
number. Send comments on the accuracy of this
				estimate of the burden and 
recommendations for reducing it
				to: U.S. Department of State (A/RPS/DIR) 
Washington, D.C.
				20520. 
				 
				
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