Approved OMB 1405-0134
Expires 07/31/2021
Estimated Burden 1 Hour*
U.S. Department of State
SUPPLEMENTAL SIV CHIEF OF MISSION APPLICATION
PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM
PLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS
1. Last Name(s) (List all spellings)
2. First Name(s) (List all spellings)
3. Full Name (In native alphabet)
‫ﻣﺤﻤﺪ رﺷﺎد اﺗﻤﺮ‬
MOHAMMAD RESHAD
ATMAR
4. Clan or Tribe Name (If applicable)
5. All other names/aliases (If applicable)
N/A
Pashton
6. Date of Birth (mm-dd-yyyy)
7. Place of Birth (City, State/Province, Country)
11 - 21 - 1956
Laghman
8. Passport Number
9. National Identity Number (Tazkera)
P03960787
1399-1000-55546
10. Sex
11. Spouse's Full Name (If married)
✘ Male
Female
Sohila Atmar
12. Father's Full Name
13. Mother's Full Name
Abdul Samad Atmar
Habiba
14. Email Address and Phone Number
Email Addresses- M.Reshad Atmar (mranajar22@gmail.com )
Phone Number - 0799222327 - 0786229249
15. List names and dates of birth for your children (currently under age 21)
1. Yalda Atmar, 24-06-2006
2. Suliman Atmar, 18-10-2008
16. List all countries you have entered in the last ten years.
(Give the year of each visit)
1-Pakistan - 2021
3-Pakistan- 2019
5-India -2015
17. List all countries that have ever issued you a passport.
Afghanistan
2-Uzbekistan- 2020
4-Pakistan 2018
Yes
19. List your last five employers, including your current employer.
Company or Employer
Work Location
Job Title
Supervisor's Name
Name
(base or city/province)
Urban development and land (MUDL)
Public and Goverment Construction
Project (PGCP)
Kabul
Architect
Architedtural Desugn of Public
and Goverment Construction
Ministry of Urban and Housing
(MUDH)
Peruzi Residential Department
Kabul
Architectural team
leader
United Infrastructure Project
(UIProjects)
Kabul
Business Developer and
Project Coordinator
Ministry of Urban Development
(MUD)
Strategic Development plan (SDP)
Kabul
Regional Planner
(Architecture)
Kabul and South Zone in Task order
#12 Counter Nacotic/police Program
(CN/PP)
South Zone Area Manager
Construction Supervisor and local
Project Manager
United Infrastructure Project
18. Have you ever lost a
passport or had one stolen?
Supervisor's Email
Address
Dates of Employment
(mm-dd-yyyy) or "Present"
From
To
Tamim Afghan et-afghan@yahoo.com 06-02-2018 On-going
✘ No
Reason for
Separation
(If no longer employed)
n/a
rroyeq@gmail.com 09 06 2015 12 21 2017
Project Contract
completion
Mazin Khalid Sadiq mazin_sadiq@uiprojects.net 01-01-2009 08-01-2014
Project Contract
completion
Abdul Ramez Royeq
Abdul Khaliq Nemat Abdul_nemat@Yahoo.com
15-05-2006 11 31 2008
Mazin Khalid Sadiq mazin_sadiq@uiprojects.net 09-01-2002 10-05-2006
20. Have you ever applied for Chief of Mission Approval?
✘ Yes
If YES, please provide the case number(s) of the application(s).
I was offered new assginment
with good benifits
Non-favorability of durability
due to security reasons of
current job at the duty station
No
NVCSIV2017262007
I understand all the information I have provided in, or in support of, this application may be provided to other U.S. government agencies authorized to use such information for purposes
including enforcement of the laws of the United States. I understand all of the information contained in this form and I certify under penalty of perjury under the laws of the United States
of America that the foregoing is complete, true, and correct. I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may
result in refusal of the visa, denial of admission to the United States, and, may subject me to criminal prosecution and/or removal from the United States.
Applicant's Signature
Date (mm-dd-yyyy)
07-28-2021
CONFIDENTIALITY AND PAPERWORK REDUCTION ACT STATEMENTS
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.
Paperwork Reduction Act Statement - Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources,
gathering the necessary data, providing the information required, and reviewing the final collection. You do not have to provide the information unless this collection displays a currently valid OMB number. Send
comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State, A/GIS/DIR, Washington, DC 20520.
DS-157
10-2017