Make an ESTA application Visa form for the USA

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Application

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Verification

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File Number

Payment

Applicant Information

Family Name *

- Enter your family name as the family name appears on your passport under the Family Name or Surname field. The family name is required to complete the application.

First (Given) Name *

- Enter your first (given) name as the first name appears on your passport under the First or Given Name field. Do not include the middle name in this field. First name is required to complete the application. If you have no first name, then enter the letters FNU which stands for First Name Unknown.

Are you known by any other names or aliases?*

- Indicate whether you are known by any other names or aliases by selecting yes or no. Answering this question is required to complete your application.

Yes No

Other Names/Aliases*

- Enter up to 10 other names or aliases by which you are known if you selected "yes" to the previous question. At least one entry is required to complete the application. For each alias: In the Family Name field, enter your alternate family name. The family name is required to complete the application. In the First (Given) Name field, enter your alternate first (given) name. Do not include the middle name in this field. The first name is required to complete the application. If you have no alternate first name, then enter the letters FNU which stands for First Name Unknown.

Country of Citizenship *

- Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.

City of Birth*

- Enter the city, town, village, or hamlet in which you were born. The city, town, village, or hamlet where you were born is required to complete the application. If you do not know the city in which you were born, enter UNKNOWN.

Country of birth *

- Choose the country in which you were born. The country where you were born is required to complete the application.

Residential country *

- Choose the country in which you reside. The country where you live is required to complete the application.

Are you a citizen of any other country?*

- Indicate whether you are a citizen of any other country. Answering this question is required to complete your application.

Yes No

Other Citizenship*

- In the Country field, choose the country of your other citizenship(s). If you answered yes above, the country is required to complete your application. In the Passport Number field, enter your passport number as it appears in your other passport(s). The passport number may contain numbers and/or characters. Please closely distinguish between the two, such as the numbers zero and one, and the letters O and I. The passport number is optional to complete your application.

Country

Passport Number

Parents*

- Enter the names of your parents. These are required to complete the application. If you do not know the name of one or both of your parents, enter UNKNOWN, for each parent. This field can include the names of your biological, adoptive, step-parent or guardian. In the Family Name field, enter your parent's family name. The family name is required to complete the application. If you do not know one or both of your parents, enter UNKNOWN. In the First (Given) Name field, enter your parent's first (given) name. Do not include the middle name in this field. The first name is required to complete the application. If your parent has no first name, or if you do not know one or both of your parents, enter UNKNOWN.

Birth Date

Day *

- Choose the day on which you were born. The day of birth is required to complete the application or to check the status of your application.

Month *

- Choose the month in which you were born. The month of birth is required to complete the application or to check the status of your application.

Year *

- Choose the year in which you were born. The year of birth is required to complete the application or to check the status of your application.

Sex *

- Choose your gender, either male or female. The sex (gender) is required to complete the application.

Male Female

E-Mail Address *

- Enter the e-mail address at which you can be contacted. The e-mail address is optional to complete the application.

Home Address

Address line 1*

- In the Address Line 1 field, enter the number and street of the location of your home address. Do not include the city and state in this field. Address line 1 is required to complete the application.

Address Line 2

City*

- In the City field, enter the city, town, village, or hamlet. The city, town, village, or hamlet is required to complete the application.

Country*

- In the Country field, choose the country. The country is required to complete the application.

Telephone Number

Country Code *

- Choose the country code of the telephone number where you can be contacted. The country code and telephone number are optional to complete the application.

Number *

- Enter the telephone number where you may be contacted. The telephone number is optional to complete the application.

Passport Information

Passport Number *

- Enter your passport number as it appears on your passport. The passport number may contain numbers and/or characters. Please closely distinguish between the number zero and the letter O. The passport number is required to complete the application or to check the status of your application.

Passport Issuing Country (Country of Citizenship) *

- Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.

Passport Issuance Date

Day *

- Choose the day on which your passport was issued, as it appears on your passport under the Date of Issue field. The day on which the passport was issued is required to complete the application.

Month *

- Choose the month in which your passport was issued, as it appears on your passport under the Date of Issue field. The month in which the passport was issued is required to complete the application.

Year *

- Choose the year in which your passport was issued, as it appears on your passport under the Date of Issue field. The year in which the passport was issued is required to complete the application.

Passport Expiration Date

Day *

- Choose the day on which your passport expires, as it appears on your passport under the Expiration Date or Extension field. The day on which the passport expires is required to complete the application.

Month *

- Choose the month in which your passport expires, as it appears on your passport under the Expiration Date or Extension field. The month in which the passport expires is required to complete the application.

Year *

- Choose the year in which your passport expires, as it appears on your passport under the Expiration Date or Extension field. The year in which the passport expires is required to complete the application.

Travel Information

City Where You are Boarding

- Enter the last city where you will board an aircraft prior to arriving in the United States on this trip. The city where the applicant will board is optional to complete the application.

Flight or Ferry Information

Carrier Name

- Choose the carrier name for the carrier on which you will be traveling to the United States, if your travel information is available. The carrier name is optional to complete the application.

Flight Number or Ferry Name

- Enter the flight number or vessel name for the carrier on which you will be traveling to the United States, if your travel information is available. The flight number or vessel name is optional to complete the application.

Address While In The United States

Address Line 1

- Enter the number and street of the location where you will stay while in the United States. Do not include the city and state in this field. The address is optional to complete the application. • If multiple locations are planned, enter the first address. • If the complete address is not known, enter the name of the hotel or location you will visit. You may update this information once confirmed. • If you are leaving the United States immediately and do not have an address, enter the words ”In Transit” and your final destination location.

Address Line 2

- Enter apartment, suite, unit, floor, building, or other, if appropriate. Do not include the city and state in this field. Address line 2 is optional to complete the application.

City

- Enter the city of the address where you will stay while in the United States. The city is optional to complete the application.

State

- Enter the state of the address where you will stay while in the United States. The state is optional to complete the application.

Emergency Contact Information In or Out of the United States

Family Name *

- Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the Family Name field, enter your emergency contact’s family name. You must complete this field to complete the application. If you have no emergency contact, enter UNKNOWN.

First (Given) Name *

- Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the First (Given) Name field, enter the emergency contact’s first name. You must complete this field to complete the application. If you have no emergency contact (or your contact has only one name), enter UNKNOWN.

E-Mail Address *

- Enter your emergency contact's e-mail address. E-mail address is required to complete the application. You may also enter UNKNOWN.

Telephone Number

Country Code *

- In the Country Code field, enter the country code of your emergency contact's telephone number. The country code is required to complete the application. If you do not have an emergency contact telephone country code you may enter zeros.

Number *

- In the Number field, enter your emergency contact's telephone number. The number is required to complete the application. If you do not have an emergency contact telephone number you may enter zeros.

Travel Information

Is your travel to the US occurring in transit to another country? *

- Indicate whether your travel to the US is occurring in transit to another country by selecting yes or no. Answering this question is required to complete your application.

Yes No

US Point of Contact Information

US Point of Contact*

- A U.S. point of contact may be a friend, relative, or business associate. If you do not have a U.S. point of contact, please enter the name, address and telephone number of the location where you will be staying (e.g. a hotel name). You may also enter UNKNOWN.

Address line 1*

Address Line 2

City*

Telephone Number*

Employment Information

Do you have a current or previous employer?*

- Indicate whether you have a current or previous employer by selecting yes or no. Answering this question is required to complete your application.

Yes No

Employer Name*

- Enter the name of your current employer. If you are not currently employed, enter the name of your previous employer. Employer name is required to complete the application. You may also enter SELF-EMPLOYED, STUDENT, CHILD, HOMEMAKER, STAY-AT-HOME PARENT, or any other word to describe your employment status.

Job Title

- Enter the job title of your current or previous employment. Job title is optional to complete this application.

Telephone Number

Address

Address line 1*

Address Line 2

City*

Country*

Do any of the following apply to you? (Answer Yes or No)

A) Do you have a communicable disease; physical or mental disorder; or are you a drug abuser or addict? *

- Communicable Diseases
  Under United States law communicable diseases of public health significance include:
  
  - Chancroid
  - Gonorrhea
  - Granuloma inguinale
  - Leprosy, infectious
  - Lymphogranuloma venereum
  - Syphilis, infectious stage
  - Tuberculosis, active
  
  - And others as determined by the Department of Health and Human Services.
  
  Physical or Mental Disorders
  With regard to physical or mental disorders, answer ”Yes” to this question if:
  
  (a) You currently have a physical or mental disorder and a history of behavior associated with the disorder that may pose or has posed a threat to your property, safety or welfare or that of others; or
  
  (b) You had a physical or mental disorder and a history of behavior associated with the disorder that has posed a threat to your property, safety or welfare or that of others and the behavior is likely to recur or lead to other harmful behavior.
  
  Answer ”No” if:
  (a) You currently have no physical or mental disorders; or
  (b) You have or had a physical or mental disorder without associated behavior that may pose or has posed a threat to your property, safety or welfare of that of others; or
  (c) You currently have a physical or mental disorder with associated behavior, but that behavior has not posed, does not currently pose nor will pose a threat to your property, safety or welfare or that of others; or
  (d) You had a physical or mental disorder with associated behavior that posed a threat to your property, safety or welfare or that of others, but that behavior is unlikely to recur.
  
  Drug Abusers and Drug Addicts
  Under United States law persons may not be admissible if they have been determined to be a drug abuser or drug addict.
  
  For further information refer to § 212(a)(1)(A) of the Immigration and Nationality Act, 8 U.S.C. § 1182(a)(1)(A), and corresponding regulations in the Code of Federal Regulations.

Yes No

B) Have you ever been arrested or convicted for an offense or crime involving moral turpitude or a violation related to a controlled substance; or have been arrested or convicted for two or more offenses for which the aggregate sentence to confinement was five years or more; or have been a controlled substance trafficker; or are you seeking entry to engage in criminal or immoral activities? *

- Crimes involving moral turpitude - Such offenses generally involve conduct which is inherently base, vile, or depraved and contrary to the accepted rules of morality and the duties owed to persons or society in general. There are factors, such as the age of the offender or the date of the offense, that may affect whether an offense will be considered a crime involving moral turpitude for purposes of the Immigration and Nationality Act.
  
  For further information refer to § 212(a)(2) of the Immigration and Nationality Act, 8 U.S.C. § 1182(a)(2), § 101(a)(43) of the Immigration and Nationality Act, 8 U.S.C. § 1101(a)(43) and corresponding regulations in the Code of Federal Regulations.

Yes No

C) Have you ever been or are you now involved in espionage or sabotage; or in terrorist activities; or genocide; or between 1933 and 1945 were you involved, in any way, in persecutions associated with Nazi Germany or its allies? *

Yes No

D) Are you seeking to work in the U.S.; or have you ever been excluded and deported; or been previously removed from the United States or procured or attempted to procure a visa or entry into the U.S. by fraud or misrepresentation? * *

- Individuals entering the United States under the Visa Waiver Program are admitted as nonimmigrant alien visitors and may not seek employment in the United States. While Visa Waiver Program travelers may not seek employment in the United States, there are many classifications of non-immigrant and immigrant employment-sponsored visas for those who qualify.
  
  For further information refer to § 212(a)(5) of the Immigration and Nationality Act, 8 U.S.C. § 1182(a)(5).
  
  For further information on non-immigrant and immigrant employment visas, refer to www.travel.state.gov.

Yes No

E) Have you ever detained, retained or withheld custody of a child from a U.S. citizen granted custody of the child? *

- Any alien who, after entry of an order by a court in the United States granting custody to a person of a United States citizen child who detains or retains the child, or withholds custody of the child, outside the United States from the person granted custody by that order, is inadmissible until the child is surrendered to the person granted custody by that order.
  
  For further information refer to § 212(a)(10)(C) of the Immigration and Nationality Act, 8 U.S.C. § 1182(a)(10)(C).

Yes No

F) Have you ever been denied a U.S. visa or entry into the U.S. or had a U.S. visa canceled? *

Yes No

If yes: when where

G) Have you ever asserted immunity from prosecution? *

- With regard to immunity from prosecution, answer ”Yes” to this question if all of the following apply:
  
  (a) you have committed a serious criminal offense in the United States as defined in 8 U.S.C. Sec. 1101(h), including any felony, at any time for which immunity from criminal jurisdiction was exercised; and
  (b) as a consequence of the offense and exercise of immunity identified in (a), you have departed from the United States; and
  (c) you have not subsequently submitted fully to the jurisdiction of the court in the United States having jurisdiction with respect to that offense.
  
  For further information refer to §212(a)(2)(E) and 101(h) of the Immigration and Nationality Act, 8 U.S.C. § 1182(a)(2)(E) and 1101(h).

Yes No

Waiver of Rights: I have read and understand that I hereby waive for the duration of my travel authorization obtained via ESTA any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

In addition to the above waiver, as a condition of each admission into the United States under the Visa Waiver Program, I agree that the submission of biometric identifiers (including fingerprints and photographs) during processing upon arrival in the United States shall reaffirm my waiver of any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

* Certification: I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.

For third-parties submitting the application on behalf of the applicant, I hereby certify that I have read to the individual whose name appears on this application (applicant) all the questions and statements on this application. I further certify that the applicant certifies that he or she has read, or has had read to him or her, all the questions and statements on this application, understands all the questions and statements on this application, and waives any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to his or her admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

The answers and information furnished in this application are true and correct to the best of the applicant's knowledge and belief.

* I accept the terms and conditions