Application for ESTA U.S.
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APPLICANT INFORMATION
First (Given) Name
Surname
Email address
Re-enter email address
(The two email addresses must match)
Gender
Male
Female
Transgender
Date of arrival
If you don't have a ticket please enter approximate departure date. If your departure is in next 72h please contact us by phone.
Are you known by any other names or aliases?
Yes
No
First (Given) Name
Surname
Date of birth
Day
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Month
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January
February
March
April
May
June
July
August
September
October
November
December
Year
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2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
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1989
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1953
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1951
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1949
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1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Country/territory of birth:
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Canary Islands
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Côte d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
England
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Ireland
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
São Tomé E Principe
Saudi Arabia
Scotland
Senegal
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wales
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Zambia
Zimbabwe
City of birth:
Passport details
Passport number
Country of Citizenship
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
Sao Tome E Principe
Saudi Arabia
Senegal
Serbia And Montenegro
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
Union Of Soviet Socialist Rep
United Arab Emirates
United Kingdom And Colonies
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Yugoslavia
Zambia
Zimbabwe
National Identification Number
Personal Identification Number
Date of issue
Day
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
------
January
February
March
April
May
June
July
August
September
October
November
December
Year
------
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Date of expiry
Day
------
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
------
January
February
March
April
May
June
July
August
September
October
November
December
Year
------
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2018
Issuing Country
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
Sao Tome E Principe
Saudi Arabia
Senegal
Serbia And Montenegro
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
Union Of Soviet Socialist Rep
United Arab Emirates
United Kingdom And Colonies
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Yugoslavia
Zambia
Zimbabwe
Have you ever been issued a passport or national identity card for travel by any other country?
Yes
No
Issuing Country
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
Sao Tome E Principe
Saudi Arabia
Senegal
Serbia And Montenegro
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
Union Of Soviet Socialist Rep
United Arab Emirates
United Kingdom And Colonies
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Yugoslavia
Zambia
Zimbabwe
Document type
Passport
National Identity card
Document Number
Expiration Year
------
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2018
OTHER CITIZENSHIP/NATIONALITY
Yes
No
Are you now, a citizen or national of any other country?
Country of Citizenship / Nationality
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
Sao Tome E Principe
Saudi Arabia
Senegal
Serbia And Montenegro
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
Union Of Soviet Socialist Rep
United Arab Emirates
United Kingdom And Colonies
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Yugoslavia
Zambia
Zimbabwe
How did you acquire citizenship / nationality from this country?
By birth
Through parents
Naturalized
Other
Have you ever been a citizen or national of any other country?
Yes
No
Country of Citizenship / Nationality
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
Sao Tome E Principe
Saudi Arabia
Senegal
Serbia And Montenegro
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
Union Of Soviet Socialist Rep
United Arab Emirates
United Kingdom And Colonies
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Yugoslavia
Zambia
Zimbabwe
GE MEMBERSHIP
Are you a member of the CBP Global Entry Program?
Yes
No
PASSID / Membership Number
PARENTS DETAILS
Father's First (Given) Name
Father's Surname
Mother's First (Given) Name
Mother's Surname
YOUR CONTACT INFORMATION
Street
Country
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Canary Islands
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Côte d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
England
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Ireland
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
São Tomé E Principe
Saudi Arabia
Scotland
Senegal
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wales
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Zambia
Zimbabwe
Apartment Number
City
State/Province/Region
Telephone Type
-----
Home
Work
Mobile
Other
Phone number
Email address
Next
Step 2
Application no:
EMPLOYMENT INFORMATION
Are you employed ?
Yes
No
Job title
Employer Name
Address (street, number)
City
State/Province/Region
Country
------
Germany, Federal Republic Of
Austria
Switzerland
Italy
Spain
------
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Azerbaijan
Azores
Bahamas, Commonwealth of the
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin, Republic of
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana, Republic Of
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon, Republic of
Canada
Canary Islands
Cape Verde Islands
Cayman Islands
Central African Republic
Chad, Republic Of
Channel Islands
Chile
China, People's Republic of
Colombia
Comoros
Congo, People's Republic of
Congo,Democratic Republic of
Cook Islands
Costa Rica
Côte d'Ivoire, Republic of
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
DPR Korea (North)
East Timor
Ecuador
Egypt
El Salvador
England
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
Fr. South. and Antarctic Lands
France
French Guiana
French Polynesia
Gabonese Republic
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea-Bissau
Guinea, Equatorial
Guinea, Republic Of
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia, Republic of
Iran
Iraq
Ireland, Republic Of
Israel
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Republic Of (South)
Kosovo, Republic of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives, Republic of
Mali, Republic Of
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro, Republic Of
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands Antilles, The
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger, Republic of
Nigeria
Northern Ireland
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Autho.Gaza/W Bank
Panama, Republic of
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Palau
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis, Fed. of
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Samoa, American
Samoa, Independent state of
San Marino
São Tomé E Principe
Saudi Arabia
Scotland
Senegal
Serbia, Republic Of
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomons, The
Somali Republic
South Africa, Republic Of
South Sudan, Republic of
Sri Lanka
St. Vincent and the Grenadines
Sudan, Republic of
Suriname
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania, United Republic Of
Thailand
Togolese Republic
Tonga
Trinidad & Tobago, Republic of
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam, Socialist Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wales
Wallis and Futuna Is., Terr.
Western Sahara
Yemen, Republic of
Zambia
Zimbabwe
Phone number
TRAVEL INFORMATION
Is your travel to the US occurring in transit to another country?
Yes
No
Address While in the U.S.
Same as U.S. Point of Contact Info Above
Yes
No
Name of Hotel/Person
Street
City
EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.
Surname
First (Given) Name
Email address
Country Code + Phone
ELIGIBILITY QUESTIONS
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-Congo
Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.
Yes
No
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
3) Have you ever violated any law related to possessing, using, or distributing illegal drugs?
Yes
No
4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?
Yes
No
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
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
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
When?
Where?
8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?
Yes
No
9) Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia or Yemen on or after March 1, 2011?
Yes
No
Country
Primary Reason
to travel as a tourist (vacation)
For personal travel or a family visit (including emergencies)
For commercial/business purposes
To carry out official duties as a full-time employee of the government of a Visa Waiver Program country
To perform miltary service in the armed forces of a Visa Waiver Program country
To conduct work as a journalist
To engage in humanitarian assistance on behalf of a humanitarian or international non-governmental organization
To carry out official duties on behalf of an international organization or regional (multilateral or inter-governmental) organization.
To carry out official duties on behalf of a sub-national government or body of VWP country
To attend an academic institution
To participate in a professional exchange or conference
To participate in a cultural exchange program
Other
Describe the reason
From
------
January
February
March
April
May
June
July
August
September
October
November
December
------
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2018
To
------
January
February
March
April
May
June
July
August
September
October
November
December
------
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2018
I accept
terms and conditions
. The price charged is 55 USD and covers the costs of the immigration service.
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