ESTA Application

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The following information is required of every nonimmigrant visitor not in possession of a visitor's visa (ESTA) who is a citizen or national of one of the countries among those belonging to the visa waiver program. Please enter all information requested. Each member of your traveling party must complete a separate application.
Mandatory fields are indicated by a red asterisk *

Personal Information

First name  * 

Last name  * 

Are you known by other names or aliases?  * 

First name  * 

Last name  * 

Sex  * 

Birthdate  * 

City of birth  * 

Country of birth  * 

Your Mother's First Name  * 

Your Mother's Last Name  * 

Your Father's First Name  * 

Your Father's Last Name  * 

Passport Information

Passport Number  * 

Passport Issuing Country  * 

Passport Issuance Date  * 

Passport Expiration Date  * 

Are you also a citizen of another country?  * 

Country of Issue  * 

Type of document  * 

Document Number  * 

Expiration Year

Other Citizenship/Nationality

Are you a citizen in another country at the moment?  * 

Country of citizenship / Nationality  * 

How did you get citizenship / nationality for this country?  * 

Other  * 

Have you ever been a citizen of another country?  * 

Country of citizenship / Nationality  * 

From  * 
To  * 

Personal Contact Information

Home address

Address Line 1  * 

Address Line 2

Apartment Number

City  * 

State/Province/Region  * 

Country  * 


Phone  * 

Calling Code & Phone Number  * 

Email  * 

Confirm your email  * 

Information on an emergency contact inside or outside USA

First Name  * 

Last Name  * 

Phone  * 

E-mail  * 

Travel Information

It is in transit to another country? (So it will not stop in the US)  * 

Points of Contact in the US  * 

Address Line 1  * 

Address Line 2

Apartment Number

City  * 

State  * 

Phone Number  * 

Social Media (Optional)

Service provider / Platform

Social Media Identity  * 

Work Information

Do you have a current employer or previous?  * 

Job Title  * 

Name of the Employer  * 

Address Line 1  * 

Address Line 2

City  * 

State/Province/Region  * 

Country  * 

Phone Number

Sign up for the GE Program

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

Entry Number / PASSID

Survey - Please answer all questions below by clicking on "Yes" or "No"

1) Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases (communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act): Cholera, Diphtheria, Tuberculosis, infectious, Plague, Smallpox, Yellow Fever, Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Cong. Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.

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?

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

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

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?

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?

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?

When  * 

Where  * 

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

9) Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia or Yemen on or after March 1, 2011?

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. * 

I accept the terms and conditions. * 

By passing to the next page I confirm that I have red all the questions and statement of this application form and have understood them. The information provided by me on the above application form is true and correct to the best of my knowledge and belief.