Esta – application

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- Fill in this application form for apply for ESTA for travel to USA.
  Your application documents, will be sent to the email address / phone number entered below. All application will automatic be saved, during the registration process. If your application is not completed within 7 days, it will be deleted.
- Your e-mail*
  
  Your application number will be sent to the email address entered below.
- Your phone number*
  At least one telephone number is required to complete the application. If you do not have a telephone number, you may provide an alternative third-party telephone number belonging to a point of contact (e.g. a family member, friend, or business associate). In the Country Code field, enter the country code of the telephone number where you may be contacted. The country code is required to complete the application. In the Phone field, enter the telephone number where you may be contacted. The telephone number is required to complete the application.
- APPLICANT INFORMATION
  Refer to your passport and enter all information in the same format.
- First (Given) Name*
  
  In the First (Given) Name field, enter ALL names exactly as they appear on your passport in the First (Given) Name field. If a second or middle name is included in the First (Given) Name field on your passport, it must also be included here. This field is required to complete the application. If you have no first name, then enter the letters FNU which stands for First Name Unknown.
- Family Name*
  
  In the Family Name field, enter your family name as the family name appears on your passport under the Family Name or Surname field. The family name is required to complete the application.
- Gender*
  - Male
  - Female
  Choose your gender, either male or female. The gender is required to complete the application.
- Date of Birth:
- Choose day*
  In the Day field, choose the day on which you were born. The day of birth is required to complete the application or to check the status of your application.
- Choose Month*
  In the Month field, choose the month in which you were born. The month of birth is required to complete the application or to check the status of your application.
- Choose Year*
  In the Year field, choose the year in which you were born. The year of birth is required to complete the application and to check the status of your application.
- PASSPORT INFORMATION
  Refer to your passport and enter all information in the same format.
- City of Birth*
  
  Enter the city, town, village, or hamlet in which you were born. The city, town, village, or hamlet where you were born is required to complete the application. If you do not know the city in which you were born, enter UNKNOWN.
- Country of Birth*
  Choose the country in which you were born. The country where you were born is required to complete the application.
- Passport Number*
  
  Enter your passport number as it appears on your passport. The passport number may contain numbers and/or characters. Please closely distinguish between the number zero and the letter O. The passport number is required to complete the application or to check the status of your application.
- Country of Citizenship*
  Choose the country of citizenship, as it appears on your passport. The country of citizenship is required to complete the application.
- Issuing Country*
  Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.
- National Identification Number*
  
  Your national ID number may or may not be found in your passport. Enter UNKNOWN if unsure. Note: • The ID must match the country that issued the passport you are using for this ESTA application. • If the ID number is not stated in your passport, it might be found on another ID card. • A National Identification Number may have been issued when you were born or when you reached a certain age. • Keep in mind that your country might be in the process of digitalizing its National Identification register.
- Personal Identification Number*
- Issuance date passport
- Choose day*
  In the Day field, choose the day on which your passport was issued, as it appears on your passport under the Date of Issue field. The day on which the passport was issued is required to complete the application.
- Choose month*
  In the Month field, choose the month in which your passport was issued, as it appears on your passport under the Date of Issue field. The month in which the passport was issued is required to complete the application.
- Choose year*
  In the Year field, choose the year in which your passport was issued, as it appears on your passport under the Date of Issue field. The year in which the passport was issued is required to complete the application.
- Expiration date passport
- Choose day*
  In the day field, choose the month in which your passport expires, as it appears on your passport under the Expiration Date field. The day in which the passport expires is required to complete the application.
- Choose month*
  In the Month field, choose the month in which your passport expires, as it appears on your passport under the Expiration Date field. The month in which the passport expires is required to complete the application.
- Choose year*
  In the Year field, choose the year in which your passport expires, as it appears on your passport under the Expiration Date field. The year in which the passport expires is required to complete the application.
- OTHER CITIZENSHIP / NATIONALITY
- Are you now, a citizen or national of any other country?
  If Yes, select the country first, then select how you acquired the citizenship/nationality.
- Country of Citizenship / Nationality*
- How did you acquire citizenship / nationality from this country?*
  Please indicate whether you acquired citizenship/nationality by birth, through parents, as a national of another country (born in the territory or possession of another country), or by other means.
- Other*
  
  You indicated "Other" as your response, please provide additional information in the text field provided.
- Have you ever been a citizen or national of any other country?
  "Previous" means at any time in the past, without limitation."
- Country of Citizenship / Nationality*
  If you have multiple passports or national identity cards for each country please list all current and expired documents for each country that issued you a document.
- Are you a member of the CBP Global Entry Program?*
- PASSID / Membership Number*
- Choose day from*
  Please enter the date you became a citizen of the selected country.
- Choose Month from*
  Please enter the date you became a citizen of the selected country.
- Choose Year from*
  Please enter the date you became a citizen of the selected country.
- Choose day to*
  Please enter the date you renounced your citizenship of the selected country.
- Choose Month to*
  Please enter the date you renounced your citizenship of the selected country.
- Choose Year to*
  Please enter the date you renounced your citizenship of the selected country.
- Have you ever been issued a passport or national identity card for travel by any other country?
  If you have never been issued any one of these documents by any other country answer "No" to this question. If you have been issued one of these documents from another country, but you do not remember the passport number or national identification card number and the year of expiration answer "UNKNOWN" in the passport number field and four zeros "0000" in the year of expiration field.
- Issuing Country*
  Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.
- Document Type*
  Please select the travel document type issued by another country.
- Document Number*
  
  Enter your document number as it appears on your travel document. The travel document may contain numbers and/or characters. Please closely distinguish between the number zero and the letter O.
- Expiration Year*
  
  If you have multiple passports or national identity cards for each country please list all current and expired documents for each country that issued you a document.
- Are you known by any other names or aliases?
  Indicate whether you are known by any other names or aliases by selecting yes or no. Answering this question is required to complete your application. Enter up to 10 other names or aliases by which you are known if you selected "yes" to this question. At least one entry is required to complete the application.
- Family Name (alias)
  
  In the Family Name field, enter your alternate family name. The family name is required to complete the application.
- First (alias)
  
  In the First (Given) Name field, enter your alternate first (given) name. Do not include the middle name in this field. The first name is required to complete the application. If you have no alternate first name, then enter the letters FNU which stands for First Name Unknown.
- YOUR CONTACT INFORMATION
  Please enter your contact information below.
- Address Line*
  
  In the Address Line field, enter the number and street of the location of your home address. Do not include the city and state in this field. Address line 1 is required to complete the application.
- City*
  
  In the City field, enter the city, town, village, or hamlet. The city, town, village, or hamlet is required to complete the application.
- State/Province/Region*
  
  In the State/Province/Region field, enter the state, province, or region. The state/province/region is required to complete the application.
- Country*
  In the Country field, choose the country. The country is required to complete the application.
- PARENTS
  Please list your parents names in the boxes below. All applicants are required to fill out this section.
- Family Name parent 1:
  
  In the Family Name field, enter your parent's family name. The family name is required to complete the application. If you do not know one or both of your parents, enter UNKNOWN.
- First (Given) Name parent 1:
  
  In the First (Given) Name field, enter your parent's first (given) name. Do not include the middle name in this field. The first name is required to complete the application. If your parent has no first name, or if you do not know one or both of your parents, enter UNKNOWN.
- Family Name parent 2:
  
  In the Family Name field, enter your parent's family name. The family name is required to complete the application. If you do not know one or both of your parents, enter UNKNOWN.
- First (Given) Name parent 2:
  
  In the First (Given) Name field, enter your parent's first (given) name. Do not include the middle name in this field. The first name is required to complete the application. If your parent has no first name, or if you do not know one or both of your parents, enter UNKNOWN.
- EMPLOYMENT INFORMATION
- Do you have a current or previous employer?*
  - No
  - Yes
  Indicate whether you have a current or previous employer by selecting yes or no. Answering this question is required to complete your application.
- Employer Name*
  
  Enter the name of your current employer (the company or organization for whom you work). If you are not currently employed, enter the name of your previous employer. Employer name is required to complete the application. You may also enter SELF-EMPLOYED, STUDENT, CHILD, HOMEMAKER, STAY-AT-HOME PARENT, or any other word to describe your employment status.
- Address Line*
  
  In the Address Line 1 field, enter the number and street of the location of the employer you listed. 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.
- City*
  
  In the City field, enter the city, town, village, or hamlet. The city, town, village, or hamlet is required to complete the application. If you do not know the city you may enter UNKNOWN.
- State/Province/Region*
  
  In the State/Province/Region field, enter the state, province, or region. The state/province/region is required to complete the application. If you do not know the state/province/region you may enter UNKNOWN.
- Country*
  In the Country field, choose the country. The country is required to complete the application. You may also select UNKNOWN
- ENTER TRAVEL INFORMATION
- Is your travel to the US occurring in transit to another country?*
  - I am transiting through the USA to another country and will NOT leave the airport.
  - I am leaving the airport and will stay at least 1 night in the USA, or go directly to the cruise ship terminal.
  Indicate whether your travel to the U.S. is occurring in transit to another country by selecting yes or no. Answering this question is required to complete your application.
- U.S. POINT OF CONTACT INFORMATION
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  Section Break
- Name*
  
  If you are unsure or have not booked your trip yet: Write Unknown
  Din kontakt i USA kan være en venn, slektning eller forretningspartner. Hvis du ikke har en kontakt i USA, vær vennlig å skriv inn navn, adresse og telefonnummer på det lokalet hvor du vil befinne deg når du er i USA (for eksempel hotellet). Skriv UNKNOWN om du er usikker.
- Address Line*
  
  If you are unsure or have not booked your trip yet: Write Unknown
  In the Address Line 1 field, enter the number and street of your US point of contact's address. Do not include the city and state in this field. Address line 1 is required to complete the application. You may also enter UNKNOWN.
- City*
  
  If you are unsure or have not booked your trip yet: Write Unknown
  In the City field, enter the city. The city is required to complete the application. You may also enter UNKNOWN.
- State*
  If you are unsure or have not booked your trip yet: Write Unknown
  In the State field, choose the state. The state is required to complete the application. You may also select UNKNOWN.
- Country Code + Phone*
  
  If you are unsure or have not booked your trip yet: Write Unknown
  Enter your U.S. point of contact's 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.
- EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.
- Family name*
  
  If you don't have any contact person or you are unsure: Write; Unknown
  Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the Family Name field, enter your emergency contact's family name. You must complete this field to complete the application. If you have no emergency contact, enter UNKNOWN.
- First name*
  
  If you don't have any contact person or you are unsure: Write; Unknown
  Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the Family Name field, enter your emergency contact's family name. You must complete this field to complete the application. If you have no emergency contact, enter UNKNOWN.
  
  Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the First (Given) Name field, enter the emergency contact's first name. You must complete this field to complete the application. If you have no emergency contact (or your contact has only one name), enter UNKNOWN.
- Email*
  
  If you don't have any contact person or you are unsure: Write; Unknown
  Enter your emergency contact's email address. Email address is required to complete the application. You may also enter UNKNOWN.
- Country Code + Phone Number*
  
  If you don't have any contact person or you are unsure: Write; Unknown
  In the Country Code field, enter the country code of your emergency contact's telephone number. The country code is required to complete the application. If you do not have an emergency contact telephone country code you may enter zeros. In the Phone field, enter your emergency contact's telephone number. The telephone number is required to complete the application. If you do not have an emergency contact telephone number you may enter zeros.
- 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.
- 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 Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011?
- Country*
  Select the country you traveled to on or after March 1, 2011."
- From month*
  Please enter the date (MONTH, YEAR) you arrived in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen.
- From year*
  Please enter the date (MONTH, YEAR) you arrived in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen.
- To month*
  Please enter the date (MONTH, YEAR) you arrived in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen.
- To year*
  Please enter the date (MONTH, YEAR) you arrived in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen.
- Primary Reason*
  - To travel as a tourist (Vacation)
  - For personal travel or a family visit (including emergencygencies)
  - To participate in a cultural exchange program.
  - Other
  - For commercial / business purposes
  - To carry out officials duties as a full-time employee of the govermment of a visa waiver program country.
  - To perform military 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 organzation
  - To carry out official duties on behalf of a sub-national government or body of a VWP country
  - To attend an academic institution
  - To participate in a professional exchange or conference
  Enter the primary purpose of your travel to Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen.
- If the purpose of your travel to Iraq, Syria, Iran, Sudan, Libya, Somalia or Yemen was for an official government or military reasons, upon arrival in the U.S., you should present to a CBP Officer evidence to support this claim.
- Other

Fill in this application form for apply for ESTA for travel to USA.

APPLICANT INFORMATION

Date of Birth:

PASSPORT INFORMATION

Issuance date passport

Expiration date passport

OTHER CITIZENSHIP / NATIONALITY

YOUR CONTACT INFORMATION

PARENTS

EMPLOYMENT INFORMATION

ENTER TRAVEL INFORMATION

U.S. POINT OF CONTACT INFORMATION

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EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.

ELIGIBILITY QUESTIONS