USA ESTA Visa Application

ESTA stands for Electronic System for Travel Authorization. ESTA is an online application system developed by the United States government to pre-screen travelers before they are allow to board an airplane or ship bound for the United States. Starting on January 12, 2009, Esta Travel Authorization is mandatory for any person entering the United States through visa waiver program.

Given Name / First Name *
Family Name / Last Name *
Are you known by any other names or aliases? *
Date Of Birth *
Gender *
City of Birth *
Country of Birth *
Father Name *
Mother Name *
In what country do you live? *
What country are you a citizen of? *
Which country issued your passport? *
When was your passport issued? *
When does your passport expire? *
What is your Passport number? *
Are you a citizen of any other country? *
Email Address *
Alternate Email Address (Optional)
Telephone Number *
Address *
Emergency Contact *

Telephone Number *

Email Address *

Is your travel to the US occurring in transit to another country? *
Do you have a current or previous employer? *
A) Do you have a communicable disease, physical or mental disorder, or are you a drug abuser or addict? *
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B) Have you ever been arrested or convicted for an offense or crime involving moral turpitude or a violation related to a controlled substance; or have been arrested or convicted for two or more offenses for which the aggregate sentence to confinement was five years or more; or have been a controlled substance trafficker; or are you seeking entry to engage in criminal or immoral activities? *
C) Have you ever been or are you now involved in espionage or sabotage; or in terrorist activities; or genocide; or between 1933 and 1945 were you involved, in any way, in persecutions associated with Nazi Germany or its allies? *
D) Are you seeking to work in the U.S or have you ever been excluded and deported; or been previously removed from the United States or procured or attempted to procure a visa or entry into the U.S by fraud or misrepresentation? *
E) Have you ever detained, retained or withheld custody of a child from a U.S citizen granted custody of the child? *
F) Have you ever been denied a U.S visa or entry into the U.S or had a U.S. visa cancelled? *
G) Have you ever asserted immunity from prosecution? *
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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.