Application Form

Please complete all mandatory fields (marked with red asterisk *)

If you do not know the answer to following questions: City of Birth, Parents, Emergency Contact, Emergency Contact Telephone Number, Emergency Contact E-mail Address, US Point of Contact, US Point of Contact Address, US Point of Contact Telephone Number, Employer Address. Please type UNKNOWN in these fields.

Personal Details

Please ensure you upload the entire passport biographic page of the traveler applying for ESTA authorization. You can do a photo of your passport page or a scan. You can upload .jpg, .jpeg, .png, .pdf files.

Are you known by any other names or aliases?*

Yes

No

*Required


Gender:*

Male

Female

*Required

Passport Information

Have you ever been issued a passport or national identity card for travel by any other country?*

Yes

No

*Required

Other Citizenship / Nationality

Are you now, a citizen or national of any other country?*

Yes

No

*Required
Have you ever been a citizen or national of any other country?*

Yes

No

*Required

GE Membership

Are you a member of the CBP Global Entry/NEXUS/SENTRI Program?*

Yes

No

*Required

Contact Details

Emergency Contact Details In or Out of the United States

Travel Information

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

Yes

No

*Required

Address While In The United States (Optional)

Are you travelling to the United States within the next 24 hours?

Yes

No

Employment Information

Do you have a current or previous employer?*

Yes

No

*Required

Additional Employment Information (Optional)

Do any of the following apply to you?

1. Do you have a communicable disease; physical or mental disorder; or are you a drug abuser or addict?* -Cholera
-Diphtheria
-Tuberculosis, infectious
-Plague
-Smallpox
-Yellow Fever
-Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo
-Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality

Yes

No

*Required
2. Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority?*

Yes

No

*Required
3. Have you ever violated any law related to possessing, using, or distributing illegal drugs?*

Yes

No

*Required
4. Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?*

Yes

No

*Required
5. Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?*

Yes

No

*Required
6. Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government?*

Yes

No

*Required
7. Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry?*

Yes

No

*Required
8. Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?*

Yes

No

*Required
9. Have you traveled to, or been present in Cuba, Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011?*

Yes

No

*Required