Pre-qualification Application for Sponsor

Use (N/A) if question does not apply to you.

Type of visa you are applying for your applicant;

 Fiancé Visa  Permanent / Settlement Visa  3 Month Holiday Visa  6 Month Holiday Visa
 Other Services
Destination………thailand……………………………..…. Estimated Traveling date (mm/dd/yy)
……10/11/2015………………………….

Your Personal Information:

Family name……Parker…………………..….…… Middle name………Charles…..……………….……..Given

name……Nicholas………………………..……….

Age ………36…………...Gender  male  female

Date of Birth (mm/dd/yy)…11/25/1978……………………………… City of

Birth……Lakewood……………….……………Country……U.S.A……………..………..

Nationality at Birth ………U.S.A.……………….………….. Current Nationality …………U.S.A.……….………

Marital status;Married  Separated  Never married  Divorced Widowed  other……Never

married………..……..

Social security number (if any)……522275056……………………………….

Personal ID number(if any) …………………..…………………..

Residential addresses: please list from present to past 3 years

1………718 Clarendon ave Leadville Co 80461………………………………………………………………………………………………

from…04/01/2015……………..…………to present time

2………3355 s flower st # 134Lakewood Co 80227………………………………………………………………………………………………

from…03/01/2014..……………………..to 04/01/2015…….…………….

3…4601 s Balsam way …#1234 Littleton Co

80123………………………………………………………………………………………………… from03/01/2013…..…………………..…to
03/01/2014…....…………….

• Your Contact information:

Initial:…………….(1)
Home telephone number…………………………………..……. Mobile phone
number…3036690761……………………….…………………………..

Email Address………………………………………………………….Fax number………….………………..…………………….………………..

Home Address/post/zip/country…718 Clarendon ave Leadville co 80461

U.S.A…..………………………………………………………………………………………………………….……

.........................................................................................................................................................................

Mailing address(if different than home)…P.O. box 1174 Leadville co 80461-

1174…………………………………………………………………………………………………………...

……………………………………………………………………………………………………………………………………..................................

• Family History and Information:

Full name Relationship to you Place of birth Resident City, Country

City/Country or Deceased
Charles Eudale Parker Father

Jannette Sue Parker Mother Wheatridge co deceased

Todd James Parker Sibling #1 Lakewood co westminster U.S.A

Sibling #2

Former Spouse #1

Former Spouse #1

Child #1

Child #2

Child #3

Spouse #1- How long was the marriage?................. Date/Place of Marriage…………….............

…………………………….Date/Place termination of marriage……………………………………………………..

Spouse #2- How long was the marriage?.................. Date/Place of Marriage……………............

…………………………….Date/Place termination of marriage……………………………………………………..

• Financial Information:
Initial:…………….(2)
Resident  Rent  Own  Other………rent……………
Monthly Salary …4416………………… Monthly Pension…0…………………… (Currency………USD……………………)

Have you filed your tax return for the last 3 years?  Yes  No
If yes, Income filed for last year yes 2015………………..………………If no, when was the last time
filed…………….…………….………

Are you paying any child support?  Yes  No

If yes, how much ………NO………………….. (Currency………………………………..)

Are you paying any alimony support?  Yes  No

If yes, how much ………………NO……………. (Currency……………………………………)

• Employment Information: please list five (5) years of previous/current employment

 Self employed  Employed  Retired  Unemployed

1. Name and Address…Golden Gates Casino 300 Main st Blackhawk co
80422………………………………………………………………………………………………..

Position you hold………poker dealer………………………………………………… from…10/24/2012………………. to present time

2. Name and Address…Ameristar casino……111 Richman Blackhawk co

80422……………………………………………………………………………………………..

Position you hold………Poker Dealer………………………………………………… from…11/24/2010………………. to

…08/31/2011………………

3. Name and Address……………………………………………………………………………………………………..

Position you hold………………………………………………………… from…………………. to …………………

• Passport details

Passport Number 438263795…………………… Country of issuance…U.S.A.………………………

Date of issue ……01/16/2008…………………..

Expiry date …01/15/2018……………………..….. This is your first  or …1st…………………… passport

Initial:…………….(3)
 • Traveling information

1. When will you be traveling back to your home country? …………1/11/2016……………..…

2. When will you coming back to revisit Thailand? ……10/11/2015………………………………..

Please list from present to past 5 times that you have traveled outside your home country:

City/Country

……………Thailand……………………..…………. from (Date) ……01/12/2014…………………. to

(Date)…02/02/2014….……………….

…………New Zealand………………………………………... from (Date) ……03/27/2008………………….. to

(Date)…04/04/2008….………………..

…………………………..………………………. from (Date) ……………………….. to (Date)………..……………..

…………………………………………..………. from (Date) ……………………….. to (Date)…...…….…………..

……………………………………………..……. from (Date) ……………………….. to (Date)……..………………..

Relationship information

Please give details of your relationship with your applicant.

Family Name……Khamkoet………………………………..……. Given Name…Sunisa……………….………………………Nick

Name…Amm……………………

Contact phone number…66 84 599 4889……………………………………………….Email

Address…[email protected]……………………………..…………………………..

Present Location……………………………………………..

1. How did you meet your applicant? When? (in person/internet/friends/etc.)……01/18/2014 In person in Pattaya at a
dance Club…candy shop on walking street ……in person………………..…….

…………………………………………………………………………………………………………………………………….……………………………...

3. Where, when, & how did this relationship begin?

….……………We met at a dance club in

Pattaya.……………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………..

4. Places traveled together

………………Pattaya, 269/1 moo 6 Banyeang Nakronthai Phitsanulok Thailand

65120………………………………………………………………………….………………………………………………………………………
Initial:…………….(4)
5. Have you traveled back to visit your applicant? How many times?

…No………We plan to see eachother october 2015 thru January

2016……………………….…………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………..

6. Do you financially support your applicant when you are not in Thailand? If yes, please give details.

……No………………………………………………………………………………………………………………………………………………….……………

7. How do you keep in touch with your applicant? How often?

………Tango we talk almost

daily……………………….……………………………………………………………………………………………………………………………………

……………………………………………………………….……………………………………………………………………………………………………

8. How is your relationship with your applicant so far?

……Great we have decided to get Married. We will get Married when We get to the United
states.………………………………………………………………………………………………………………………….……………………………………

………………………………………………………………………………………………………………………………………………………………….…

9. Overall feel of the relationship

……………I don't want to be away from her any longer. We get along very well and can talk about everything. I can't
think of anyone else I want to spend the rest of my life
with.………………………………………………………………………………………………………………………….……………………………

……………………………………………………………………………………………………………………………………………………………………..

10. Where do you see the relationship in the next 2-3 years?

….……………We plan to have her Move to the U.S.A and get married. Where we will live together in my home
here.…………………………………………………………………………………………………………………………………………………...

……………………………………………………………………………………………………………………………………………………………………..

TSL & Associate Terms & Conditions:

-TSL & Associate will not be responsible for any falsified information given to us by the sponsor & applicant.

-Any falsified information given to us will have a negative impact on the visa application and most likely result in the
denial of the visa applied for.

- TSL & Associate will not be responsible for any hidden information not revealed to us that has direct impact
on foreign government’s policy regarding traveling history and visa denial history of the applicant.

-TSL & Associate will not be responsible for the sponsor’s lack or unwilling to provide supporting documents requested
by either TSL & Associate or the Embassy of the country the applicant is applying for.

Initial:…………….(5)
- Every effort will be made to expedite your case promptly and efficiently according to the highest legal and
ethical standards. Please understand, however, that at times there are processing delays that are beyond the control
of our office due to government bureaucracy.

-TSL & Associate reserves the right to apply for an alternative type of visa or appeal the refusal if the primary visa
applied for is refused for the applicant.

-Please note that 50% of the success of the visa application is based on the success of the interview with the
immigration office at the embassy of the country applied for. TSL & Associate will not be responsible for any
incorrect/falsified information given by the applicant to the interviewing officer at the time of the interview.

-Once your partner is granted the visa applied for, please follow all visa policies and procedures which include staying
over the expiration date of the visa.

-Any violation of staying over the expiration date of the visa may result in denial of re-entry, returning, re-visiting that
country and other countries for a period up to five years to life.

-All information provided to TSL & Associate Thailand Co., LTD are personal and confidential.

__Nicholas Charles Parker_________________________________

______________________

Signature* Date (mm/dd/yy)06/01/2015

___Nicholas Charles Parker________________________________

(Print Name)

*I hereby affirm that the information given on this form is correct to the best of my knowledge and belief. I understand that TSL & Associate has no authority
whatsoever to rush or influence the embassy to process the application and/or granting the visa I am applying for.
TSL & Associate will submit the application within 5 working days after all required documents and information have been given from me. After
submitting the case to the embassy, TSL & Associate will monitor its progress and regularly keep me informed.
Any false information may result in denial of my applicant’s visa application.
I hereby authorize TSL & Associate to proceed with the visa application for my applicant. Any charges incurred in connection with the visa application and flight
tickets or arrangements for my applicant can be billed to me or my joint sponsor.
TSL & Associate cancellation & refund policy:
In case of any cancellation, TSL & Associate reserves the right to issue only company credit refund back to whose name appears above. Any refund or credit must
be notified to TSL & Associate by telephone, facsimile, or email in which any refunds will be given by company check or company voucher. I, the card holder,
cannot dispute any charges incurred on my credit card in connection with the visa application or flight arrangements for my applicant.

Initial:…………….(6)