H1B Data Sheet
(Please Don’t change the text)
Family name (Last Name): Das
Given Name (First Name): Dev Prasad
Middle Name:
Address: P-11 State Bank Park,
Pora-asthala, Thakurpur
Kolkata-700063
Date of Birth: 02-03-1976
(MM/DD/YYYY):
Country of Birth: Indian
Province (STATE) of Birth: West Bengal
Social Security # (if
applicable): xxx-xx-xxxx
A# (if applicable):
The prior petition or
application receipt # (if
applicable):
Passport Number: A8830544
Date Passport Issued 27-06-2000
(MM/DD/YYYY):
Date Passport Expires 26-06-2010
(MM/DD/YYYY):
If in the United States, complete the following:
Date of Last Arrival
(MM/DD/YYYY)
I-94 #
Current Nonimmigrant Status
I-94 Expires (MM/DD/YYYY)
Current U.S. Address
If you are outside the U.S., complete the following:
U.S. consulate City and Kolkata and India
Foreign Country you will
prefer for visa revalidation:
Your Foreign Address (country
you will go for visa
revalidation):
Ever been given H1B classification you are now requesting? If yes then please list the
durations of Approvals and the petitioner’s name.
NAME of Petitioner Valid From Valid till
Redact systems Pvt. Ltd. May 05 2001 Aug 06 2001
Redact systems Pvt. Ltd. APR 14 2003 APR 21 2004
Phoneix Computing(India)
List yours and any dependent family members' prior periods of stay in H classification in
the U.S. for the last six years. Be sure to list only those periods in which you and/or family
members were actually in the U.S. in an H classification. If more space is needed, add more
columns.
NAME of Petitioner Valid From Valid till
Ever been denied the H1B classification? If yes then please mention when and who was the
petitioner.
NAME of Petitioner Receipt # Date of Denial
Beneficiary's Highest Level of Education:
Major/Primary Field of Study:
Has the beneficiary of this petition earned a master's or higher degree from a U.S.
institution of higher education? (YES/NO)
If Yes then:
Name of the U.S. institution of higher education:
Date Degree Awarded:
Type of U.S. Degree:
Address of the U.S. institution of higher education:
We prefer scanning and emailing your document as a PDF file. Scan passport as its own
file, Degree certificates as a separate file, and mark sheets as a separate file and so on.
Upload your files to any online storage place, like megaupload or xdrive or others, and send
the link by mail to [email protected] with copy to [email protected]
If you are going to send the document by mail, send it to:
Droisys, Inc. 4800 Patrick Henry Dr., Santa Clara, CA 95054