ESTA Online-Application

  • 1 - Fill the ESTA Application Form.
  • 2 - Check your personal information and payment.
  • 3 - Receive immediately by email the confirmation of U.S. Government Authorization and print it.

Traveler information:

Title :
Family Name :
First Name :
Are you known by any other names or aliases ? (optionnal)
Date of Birth:
City of birth :
Country of birth :
Gender :
Marital status:
Email address:
Confirm your email address:

Parent information:

Father's family name :
Father's first name :
Mother's family name :
Mother's first name :

Further information:

Address :
Additional address:
City :
Zip code :
Country :
Cellphone number :
Phone number :

Information about your Passport

Nationality :
Passport number :
Passport's country :
Passport issuance date:
Passport expiry date:
Boarding city (optional) :

Your Travel to the USA.

Is your travel to the US occuring in transit to another country?
Address during your stay in the U.S (optional) :
Additional address (optional):
City during your stay in the U.S (optional):
State (optional):
Airline or sea (optional):
Flight number (optional):

Have you been, or are you a citizen of any other country?

Country
How did you acquire citizenship / nationality from this country? :

Emergency contact information in or out of the United States

Emergency contact family name :
Emergency contact first name :
Telephone number :
Email Address :

Have you ever been issued a passport or national identity card for travel by any other country?

If so, please specify :
The type of document:
Passport number or identity card:
Year of expiry:

Employment information (only if you have a current or previous employer)

Have you ever had a job?
Employer name :
Address line 1 :
Address line 2:
City :
Country :

Details about your health and your character

Do you have a communicable disease; physical or mental disorder; or are you a drug abuser or addict? *
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?
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?
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?
Have you ever detained, retained or withheld custody of a child from a U.S. citizen granted custody of the child?
Have you ever been denied a U.S. visa or entry into the U.S. or had a U.S. visa canceled ?
Have you ever asserted immunity from prosecution ?
Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?

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.

Have you traveled to, or been present in Iraq, Syria, Iran, or Sudan on or after March 1, 2011?

Additionnals Details

 I have read and understand that I hereby waive for the duration of my travel authorization obtained via ESTA any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.In addition to the above waiver, as a condition of each admission into the United States under the Visa Waiver Program, I agree that the submission of biometric identifiers (including fingerprints and photographs) during processing upon arrival in the United States shall reaffirm my waiver of any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to my admissibility, or to contest, other than on the basis of an application for asylum, any removal action arising from an application for admission under the Visa Waiver Program.

Terms and Conditions

I accept the Terms and Conditions of Service
 
 
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