ESTA APPLICATION FORM

*Please provide all responses in English.
Enter all information exactly as appear in your passport.
GENERAL INFORMATION

No    Yes
Alias
  

Male    Female
YOUR CONTACT INFORMATION
SOCIAL MEDIA (OPTIONAL)
Please enter information associated with your online presence.
  
PARENTS
PASSPORT INFORMATION

Accepted formats: JPG, PNG, or PDF (max 5MB)
Please upload your biographic passport page as is shown on the sample passport image, make sure the Passport's entire biographic page is captured, the horizontal code (mrz) is contained within the full width of the photograph and the photograph is clear and not blurry.
Passport sample

Accepted formats: JPG/JPEG, PNG (max 5MB)
Please upload your selfie, full face showing head and shoulders only. Use color photo on a plain background and no sunglasses, hats, or masks. No filters or major editing.
Selfie sample
Please ensure the selfie is not a copy of the photo in the passport. If you submit the same photo, the application might be canceled.

If you are applying on behalf of someone else, please ensure the selfie is a photo of the passport holder.

No   Yes  
  

No   Yes  
  

No   Yes  
  
You have indicated that you are not a citizen or national of your country of birth.
From the list below, please select ALL statements that apply with respect to your country of birth:
Did not acquire citizenship at birth or have never held citizenship in birth country
Renounced citizenship of birth country
Have not lived or resided in birth country within the past five years
Have not held a passport or national identity card from birth country within the past five years
Other
GE/NEXUS/SENTRI MEMBERSHIP

No    Yes
EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.
EMPLOYMENT INFORMATION

No   Yes
ELIGIBILITY QUESTIONS
Social And Medical Information
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.
No    Yes
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? *
No    Yes
3) Have you ever violated any law related to possessing, using, or distributing illegal drugs? *
No    Yes
4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide? *
No    Yes
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? *
No    Yes
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? *
No    Yes
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? *
No    Yes
8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government? *
No    Yes
9) Have you traveled to, or been present in Iraq, Syria, Iran, or Sudan on or after March 1, 2011? *
No    Yes
  
ENTER TRAVEL INFORMATION
U.S. Point Of Contact Information

No    Yes
Address While In The U.S.

No   Yes  
Verification *
For verification purposes, please re-enter the following information, as shown on your ESTA-eligible passport.
Certification
I, the applicant, hereby certify that I have read, or have 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 provided by me in this application are true and correct to the best of my knowledge and belief.
PLEASE NOTE
To proceed click 'Submit Application For U.S. Travel' below, this will take you to Payment Page. You have a choice of payment method.
The cost is USD $103.00, you will need a Credit Card or Debit Card to make payment.
Declaration of Applicant
  • I declare that the information I have given in this ESTA application is truthful, complete and correct.
  • I have read and understand the Terms and Conditions.
  • I agree that by typing my name and clicking I agree, I am electronically signing my application for ESTA.
To sign, type your name as it appears on your passport.
Step 2: Review Your Application
Please review all information for accuracy before submitting your application. If information is inaccurate, please make corrections. Select "Submit Application For U.S. Travel" if/when all information is correct.