US ESTA - Application Form

Personal Details

First Name * Enter your first name exactly as shown in your passport.

Last Name * Enter your last name exactly as shown in your passport.

Gender *

Male

Female

Date of birth *

City of Birth *

Country of Birth *

Country of Citizenship *

National Identification Number * If you don't know or you haven't you can put UNKNOWN.

Email Address * Where will you receive your VISA pdf.

Confirm Email Address *

Alternative email Address (optional)

Mobile/Cell Telephone *

Next Step

Parent's information

Father first Name *

Father last Name *

Mother first Name *

Mother last Name *

Next Step

Passport Details

Country of Passport *

Passport Number * 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.

Passport Date of Issue *

Passport Expiry Date *

Next Step

Other Citizenship, Nationality, Passport

Are you currently a citizen or national of any other country? * Indicate whether you are a national or citizen of more than one country.

Yes

No

Other Country Citizenship Current *

How did you acquire citizenship / nationality from this country? *

Other *

In the past have you ever been a citizen or national of any other country? * "In the past" means that you have been citizen but are not anymore citizen or national of that country.

Yes

No

Other Country Citizenship in the Past *

Have you ever been issued a passport or national identity card for travel by any other country? * If you have never been issued any one of these documents by any other country answer "No" to this question. If you have been issued one of these documents from another country, but you do not remember the passport number or national identification card number and the year of expiration answer "UNKNOWN" in the passport number field and four zeros "0000" in the year of expiration field.

Yes

No

Issuing Country *

Document type *

Document Number (optional)

Expiration year (optional)

Next Step

Home Address of Residence

Home Address line 1 *

Home Address line 2 (optional)

Home Address Postal Code *

Apartment number (optional)

Home Address City *

Home Address State/Province/Region *

Home Address Country *

Next Step

Itinerary

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

Yes

No

Do you have a current or previous employer? *

Yes

No

Employer name *

Address line 1 *

Address line 2 (optional)

City *

State/Province/Region *

Country *

Employer telephone (optional)

Job title (optional)

Next Step

Emergency contact (optional)

First Name

Last Name

Mobile/Cell Telephone

Declaration of Applicant

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. By clicking on Continue to Review and Pay button, I certify that I have read and understood the above questions. *

I have read and understood the terms and conditions and privacy policy. *

Continue to Review and Pay

VISA USA Application

A

B

C

D

E

F

G

H

I