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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.

Only upload a photo of the information page of the passport where you find this information:
  • Family Name
  • First (Given) Name
  • Gender
  • Date of Birth
  • Country of Citizenship
  • Issuing Country
  • Passport Number
  • Issuance Date
  • Expiration Date
The machine-readable strip at the bottom of the page has to be visible on the photo.
 

APPLICANT INFORMATION

Refer to your passport and enter all information in the same format.
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.
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.
Choose your gender, either male or female. The gender is required to complete the application.

Date of Birth:

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.
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. 
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.
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.
Choose the country in which you were born. The country where you were born is required to complete the application.
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.
Choose the country of citizenship, as it appears on your passport. The country of citizenship is required to complete the application.
Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.
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.

Issuance date passport

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. 
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. 
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

In the day field, choose the day 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.
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.
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

If Yes, select the country first, then select how you acquired the citizenship/nationality.
"Previous" means at any time in the past, without limitation."
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.
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.

YOUR CONTACT INFORMATION

Please enter your contact information below.
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.
In the City field, enter the city, town, village, or hamlet. The city, town, village, or hamlet is required to complete the application.
In the State/Province/Region field, enter the state, province, or region. The state/province/region is required to complete the application.
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.
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.
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.
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.
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.

EMPLOYMENT INFORMATION

Indicate whether you have a current or previous employer by selecting yes or no. Answering this question is required to complete your application.
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.
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.

If you are unsure,Write: Unknown

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.

If you are unsure,Write: Unknown

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.

If you are unsure,Write: Unknown

In the Country field, choose the country. The country is required to complete the application. You may also select UNKNOWN

ENTER TRAVEL INFORMATION

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

Your contact in the US may be a friend, relative or business partner. If you do not have a contact in the US, please enter the name, address and telephone number of the premises where you will be in the US (for example, the hotel). Write UNKNOWN if you are unsure.

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.

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.

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.

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.

If you are unsure or have not booked your trip yet: Write Unknown

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

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.

If 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.

If 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.

If 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.

If you are unsure,Write: Unknown

ELIGIBILITY QUESTIONS

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.