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ビザ訂正リクエストフォーム

発給されたビザに間違いがあった場合はこのフォームをお送りください。訂正のリクエストが適正であるかを領事が判断し、その後の手続きについてEメールでお知らせします。

なお、訂正が可能なのは、非移民ビザは未使用で発給から1年以内、移民ビザは未使用で有効期限内のものに限ります。

このフォームはビザが正しく印刷されていなかった場合で、訂正を問い合わせるための専用フォームです。その他のご質問をお受けすることはできません。ビザに関するご質問はビザ情報サービスをご利用ください。

電子渡航認証システム（ESTA）はビザではありません。ESTA申請後の状況確認や、ESTA拒否の理由、または原因の詳細については大使館・領事館ではお答えできません。 ESTAに関する一般的な質問は、CBPのウェブサイト https://help.cbp.gov をご参照ください。ESTA情報の訂正は FAQ（よくある質問） をご覧ください。

生年月日:
性別:
ビザ申請地
渡航予定日:(Required)
Privacy Act Statement

AUTHORITIES: The information on this form is requested pursuant to Title 8 of the United States Code (U.S.C.), including specifically 8 U.S.C. § 1104 (Powers and duties of Secretary of State) and §§ 1201-1202 (Issuance of visas; Application for Visas).

PURPOSE: We are requesting this information in order to review your visa case, to facilitate activities such as scheduling your appointment for a service, and conducting administrative processing for services including immigrant visa appointments, returning resident visas and boarding foils.

ROUTINE USE: This information may be disclosed to another domestic government agency, a private contractor, a foreign government agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities, and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non-citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices Visa Records, STATE-39

DISCLOSURE: Providing this information is voluntary. Failure to provide all the information requested on this form may result in the individual and/or authorized representative’s inability to obtain relevant information regarding a consular service request.

Confidentiality Statement: INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation, amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be made available to a court which certifies that the information contained in such records is needed in a case pending before the court.