FILL OUT THE ELECTRONIC VISA APPLICATION (ESTA)

Please enter the name, first name (s) and passport number exactly as they appear on your passport information page.

The Electronic System for Travel Authorization performs checks against law enforcement databases. All travelers seeking admission to the United States under the Visa Waiver Program are required to obtain an electronic travel authorization using this system prior to being granted boarding.

If your electronic travel authorization application is approved, it establishes that you are eligible to travel, but does not establish that you are admissible to the United States under the Visa Waiver Program. Upon arrival to the United States, you will be inspected by a U.S. Customs and Border Protection Officer at a port of entry who may determine that you are inadmissible under the Visa Waiver Program or for any reason under United States law.

A determination that you are not eligible for electronic travel authorization does not preclude you from applying for a visa to travel to the United States.

All information provided by you, or on your behalf by a designated third party, must be true and correct. An electronic travel authorization may be revoked at any time and for any reason, such as new information influencing eligibility. You may be subject to administrative or criminal penalties if you knowingly and willfully make a materially false, fictitious, or fraudulent statement or representation in an electronic travel authorization application submitted by you or on your behalf.

We are a private agency, with no ties to government authorities, our business is to handle electronic visa applications. Our mission is to control the information of the visa applicants, send it to the immigration services and to ensure the interface so that the electronic visa applications are accepted and issued in the best possible time.

WARNING: If upon application for admission to the United States at a port of entry you are admitted under the Visa Waiver Program (VWP) by a US Customs and Border Protection Officer, you may not accept unauthorized employment; or attend school; or represent the foreign information media during your visit under the program. You may not apply for: 1) a change of nonimmigrant status, 2) an extension of stay, or 3) adjustment of status to temporary or permanent resident, unless eligible under section 245(c)(4) of the Immigration and Nationality Act. Violation of these terms will subject you to REMOVAL.

Information

? Enter your Family (last) name as it appears in your passport in the Last name field. Last name is required to complete the application.

Family Name *

? Enter your first name here as it appears in your passport in the First Name field. The first name is required to complete the application.

First (Given) Name *

? Enter your middle name here, as it appears in your passport in the First name field. First name 2 is optional to continue the request.

First Name 2

? Please indicate your gender. Required to complete the application.

Gender *

? Enter the email address at which you can be contacted. The email address is required to complete the request. If you don't have an e-mail address, you may provide the e-mail address of a third party (for example, a family member, friend or colleague).

E-mail Address *

? Confirm here the email address you entered in the first Email field

E-mail Confirmation *

? Indicate your date of birth. Date of birth is required to complete the request.

Birth Date *

? Please confirm your date of birth

Birth Date Confirmation *

? Indicate here the town, chief town, village or hamlet where you were born. The city, town, village or hamlet where you were born is required to complete the request. If you don't know the city where you were born, type UNKNOWN.

Place of Birth *

? Choose the country where you were born. Country of birth is required to complete the request.

Country of Birth *

Address

? In this Line 1 Address field, enter your home address number and street. Don't include city and state in this field. Line 1 address is required to complete the application.

Address Line 1 *

? In this field Address line 2, enter the floor, building or other additional information related to your address. Don't include city and state in this field. The address line 2 is optional to be able to continue the request.

Address Line 2

? Enter the postal code of your city

Postcode *

? Indicate here the city, the chief town, the village or the hamlet. The city, town, village or hamlet is required to complete the application.

Town or City *

? Indicate your country of residence. The country is required to complete the application.

Country *

? At least one telephone number is required to complete the application. If you don't have a telephone number, you can give an alternative telephone number of a third party belonging to a contact point (for example a family member, friend or colleague). The telephone number is required to complete the application.

Mobile Phone *

Landline Phone

Passport Information

Travel Information

? Indicate your intended date of travel (Optional information)

Date of Departure

? Kindly reply by Yes or No

Is your trip to the United States a transit to another country ? *

NO YES

? 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.

U.S. Point Name Of Contact Information

? In the Address Line 1 field, enter the number and street of your U.S. Point of Contact's address. Do not include the city and state in this field. Address line 1 is required to complete the application. If you do not know the address of the employer you listed you may enter UNKNOWN.

Address Line 1

? In the Address Line 2 field, enter floor, building, or other, as appropriate. Do not include the city and state in this field. Address line 2 is optional to complete the application.

Address Line 2

? In the Apartment Number field, enter apartment, suite, unit, or other, as appropriate. Do not include the city and state in this field. Apartment number is optional to complete the application.

Apartment Number

? In the City field, enter the city. The city is required to complete the application. You may also enter UNKNOWN.

City

? In the State field, choose the state. The state is required to complete the application. You may also select UNKNOWN.

State

? Enter your U.S. point of contact telephone number. The number is required to complete the application. If you do not have a point of contact telephone number you may enter zeros.

Phone Number

? Is your address while in the United States the same as the American Contact Point address indicated above ?

Is your address while in the United States the same as the American Contact Point address indicated above ?

NO YES

? In the Address Line 1 field, 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. Address line 1 is optional to complete the application.

Address Line 1

? In the Address Line 2 field, enter floor, building, or other, as appropriate. Do not include the city and state in this field. Address line 2 is optional to complete the application.

Address Line 2

? In the Apartment Number field, enter apartment, suite, unit, or other, as appropriate. Do not include the city and state in this field. Apartment number is optional to complete the application.

Apartment Number

? In the City field, enter the city. The city is optional to complete the application.

City

? In the State field, choose the state. The state is optional to complete the application.

State

Additional Information

Employer

? Kindly indicate if you have a current or previous occupation

Are you or have you been employed (in your country of residence)? *

NO YES

? Kindly indicate your employer name

Employer Name *

? Kindly indicate the employer address

Employer Address *

? Employer City

City *

? Employer Country

Country *

Parents

? Parent 1: Last name

Parent 1: Last Name *

? Parent 1: First name

Parent 1: First Name *

? Parent 2: Last name

Parent 2: Last Name *

? Parent 2: First name

Parent 2: First Name *

Emergency Contact

? please indicate a contact name in case of emergency

Name *

? Contact's first name

First Name *

? Contact's phone

Telephone *

? Contact's Email

E-mail *

Eligibility Questions

Summary

General Information

Family Name :
First (Given) Name :
First Name 2 :
Gender :
E-mail Address :
E-mail Confirmation :
Date of Birth :
Place of Birth :
Country of Birth :
Address Line 1 :
Address Line 2 :
Postcode :
Town or City :
Country :
Mobile Phone :
Landline Phone :
Passport Number :
Date of Issue :
Expiration Date :
Issuing Country :
Citizenship :
National identity Number :

Other Citizenship/Nationality

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

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

Have you already held a passport or identity card to get into another country ? :

Travel information

Date of Departure :

Is your trip to the United States a transit to another country ? :

Is your address while in the United States the same as the American Contact Point address indicated above ? :

Employer

Are you or have you been employed (in your country of residence)?

Parents

Parent 1: Last Name :
Parent 1: First Name :
Parent 2: Last Name :
Parent 2: First Name :

Emergency Contact

Name :
First Name :
Telephone :
E-mail :

Eligibility Questions

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: Diphtheria, Infectious Tuberculosis, Plague, Smallpox, Yellow Fever, Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean- CongoSevere acute respiratory illnesses capable of transmission to other persons and likely to cause mortality ?
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 ?
Have you ever violated any law related to possessing, using, or distributing illegal drugs ?
Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide ?
Have you ever committed fraud or made a false declaration to obtain or help a third-party obtain a Authorization for or entry into the United States ?
Are you currently seeking employment in the United States or have you been employed in the United States without the prior authorisation of the US Government ?
Have you ever been denied a U.S. Authorization 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 :

Have you ever overstayed the period of residence granted to you by the US Government ?
Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia or Yemen on or after March 1, 2011 ?

Reason :

Other :

Please identify the company, business entity, or organization on behalf of which you traveled to Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen to engage in journalism.
What was your official position / title with the company, business entity, or organization identified ?

Have you ever been issued an I-Visa by a United States Embassy or Consulate? If "Yes," please provide your I-Visa Number, if known
I-Visa Number

Please identify the organization or entity on behalf of which you traveled to Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen for humanitarian purposes.
Does your organization or business entity have consultative status with the United Nations Economic and Social Council ?
What was your official position/position with the company, business entity or organization mentioned?
If different than your current employer, please provide contact information for the organization or entity identified, including primary address and telephone number.
Please provide your Iranian, Iraqi, Libyan, North Korean, Somalian, Sudanese, Syrian or Yemeni Visa Number related to your humanitarian travel.
If your organization or business entity has been a recipient of U.S. government funding for humanitarian assistance within the last five years, please provide the most recent grant number.
Please provide information about the type of work you were doing in this country during this time.
Please include any information you are willing to share about other NGOs or international, national or state agencies with which you worked.
Any additional comments
Please identify the international (multilateral or intergovernmental) organization or regional (multilateral or inter-governmental) organization on behalf of which you traveled to Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen
Please identify the sub-national government or body of a VWP country on behalf of which you traveled to Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen.
What was your official position / title with the organization or government identified ?
Please provide your Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen visa number in connection with your official travel on behalf of a regional or international organization or subnational government.

Have you ever been issued a G-Visa or A-Visa by a United States Embassy or Consulate? If "Yes," please provide your G-Visa or A-Visa, if known.
Have you ever been issued a United Nations Laissez-Passer? If "Yes," please provide your Laissez-Passer number.

G-Visa or A-Visa :
Laissez-Passer Number :

I fully accept the terms and conditions. I certify the accuracy of all the information provided on this e-Visa application, any error or omission may result in the rejection of my application. I take note that any false statement will automatically result in the cancellation of my e-Visa application without any possibility of refund. I accept that in the case of services immediately executed after my order, the right of withdrawal of 14 days does not apply. In case of a cancellation request during the processing, my order will be refunded except for the processing fee. In case of express cancellation, if the request has not yet been processed, the order will be fully refunded. The request for express cancellation must be made by e-mail, chat or telephone to the customer service.

FILL OUT THE ELECTRONIC VISA APPLICATION (ESTA)

Information

Address

Passport Information

You must follow one of these instructions to upload a passport photo from your mobile phone :

SAMPLE PASSPORT

Other Citizenship/Nationality

Travel Information

Additional Information

Employer

Parents

Emergency Contact

Eligibility Questions

Please check your answers, as Authorization may be denied if you answer 'Yes' to any of the following questions

Summary

General Information

Other Citizenship/Nationality

Travel information

Employer

Parents

Emergency Contact

Eligibility Questions

FILL OUT THE ELECTRONIC VISA APPLICATION (ESTA)

Information

Address

Passport Information

You must follow one of these instructions to upload a passport photo from your mobile phone : GET NEW CODE

SAMPLE PASSPORT

Other Citizenship/Nationality

Travel Information

Additional Information

Employer

Parents

Emergency Contact

Eligibility Questions

Please check your answers, as Authorization may be denied if you answer 'Yes' to any of the following questions

Summary

General Information

Other Citizenship/Nationality

Travel information

Employer

Parents

Emergency Contact

Eligibility Questions

You must follow one of these instructions to upload a passport photo from your mobile phone :