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About Us
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Intake Form

Welcome to your first step in becoming a Per Capita private client. Please provide basic information for our internal process, to help guide you through your international travelling plans.

First Name

Middle Name (if applicable)

Last Name

Date of Birth

Full Home Address

Current Passport Country

Mailing Address

Best Contact Number

Emergency Contact

Name

Phone

Are you traveling aloneYesNoIf the answer is no, please note, you will need to travel alone at first. Upon successful arrival, you may begin processing others who are considered relatives. Please provide the following

How many travelers:

Are they relatives or business colleagues

1st traveler

Full name of 1st traveler

Date of Birth of 1st traveler

Country of Birth of 1st traveler

2nd traveler

Full name of 2nd traveler

Date of Birth of 2nd traveler

Country of Birth of 2nd traveler

3rd traveler

Full name of 3rd traveler

Date of Birth of 3rd traveler

Country of Birth of 3rd traveler

What is your current source of employment?

How many years have you been active in this trade?

Please provide an overview of all your work experience.

Do you own residential or commercial property in your home country?

What languages do you speaks?

Have you ever applied for a United States VISA? If yes, what was the date of the application and what type did you apply for?

If you were denied any VISA application, please briefly explain the reason for denial:

If you have been issued any of the following Non-Immigrant VISAS, provide a check-mark:

B-1 (Athlete, amateur or professional, domestic employee, business visitor)

E-3 (Australian professional specialty)

BCC (Boarder Crossing Card: Mexico)

CW-1 (CNMI-only transitional worker)

D (Crewmember)

A (Diplomat or foreign government official)

G1-G5, NATO (Employee of a designated international organization or NATO)

A-2 NATO1-6 (Foreign military personnel stationed in the U.S.)

O (Foreign national with extraordinary ability in Sciences, Arts, Education, Business or Athletics)

H-1B1 – Chile /H-1B1 – Singapore (Free Trade Agreement (FTA) Professional Chile, Singapore)

Q (International cultural exchange visitor

L (Intra-company transferee)

B-2 (Medical treatment, visitor for)

I (Media, journalist)

TN/TD (NAFTA professional worker: Mexico, Canada)

P (Performing athlete, artist, entertainer)

J, H-1B (Physician)

R (Religious worker)

H-1B (Specialty occupations in fields requiring highly specialized knowledge)

F, M (Student: academic, vocational)

H-2A (Temporary agricultural worker)

H-2B (Temporary worker performing other services or labor of a temporary or seasonal nature)

H-3 (Training in a program not primarily for employment)

E (Treaty trader/treaty investor)

C (Transiting the United States)

U (Victim of Criminal Activity)

T (Victim of Human Trafficking)

V (Nonimmigrant (V) Visa for spouse and children of a lawful permanent resident (LPR))

Do you have any immediate family or relatives currently in the United States?YesNo

Do you have any experience in business management, such as managerial, executive assistant, or as a trustworthy consultant?YesNoIf yes, please explain your experience

please explain your experience

What is your current financial situation (For example: Are you indebted to any financial institutions in your country or any country)?

Will you have funds to support your initial stay in the United States? If, so what is the approximate amount?

What are you short term goals in accessing the United States?

What are you long term goals in accessing the United States?

Are you interested in our work placement programs or are you interested in investing in your own United States business?

Are you interested in investment opportunities with established United States companies to secure long extended stay periods in the United States?YesNo

how much can you invest?

What is the source of funds for the above-mentioned investment amount?

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