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 rajender.gupta@droisys.com with copy to amit@droisys.com

If you are going to send the document by mail, send it to:

Droisys, Inc. 4800 Patrick Henry Dr., Santa Clara, CA 95054