UNITED STATES VISA WAIVER (ESTA)

This questionnaire will allow us to complete an ESTA (Electronic System for Travel Authorization) application on your behalf. Please provide all information requested – any unanswered questions will delay your application.

 

NB. We are only able to process pre-paid applications via this form. If you have landed here via a direct Google search, please return to our search page in order to begin the visa application process. 

 

 

 

APPLICANT/PASSPORT INFORMATION

Please refer to your passport and use the same format to enter all information.

 

 

 

 

 

 

 

IF YOUR PASSPORT WASN'T ISSUED BY ONE OF THE COUNTRIES LISTED ABOVE, YOU ARE NOT ELIGIBLE TO APPLY FOR AN ESTA.

Please click here to return to our search page, or visit the embassy website if you require further details.

 

 

 

 

 

 

OTHER CITIZENSHIP/NATIONALITY

 

 

 

 

 

GE MEMBERSHIP

 

 

 

PARENTS

NB. If you do not know the names of one or both parents, please enter ‘unknown’.

 

 

 

 

YOUR CONTACT INFORMATION

 

 

 

 

 

 

SOCIAL MEDIA (OPTIONAL)

 

 

 

EMPLOYMENT INFORMATION

 

 

 

TRAVEL INFORMATION

 

 

 

 

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

 

 

 

ELIGIBILITY QUESTIONS

 

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, inc. Ebola, Lassa, Marburg,

Crimean-Congo; Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.

 

 

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?

 

 

Have you ever violated any law related to possessing, using, or distributing illegal drugs?

 

 

Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?

 

 

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?

 

 

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?

 

 

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?

 

 

Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?

 

 

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

 

 

 

 

 

 

 

 

DISCLAIMER

The Electronic System for Travel Authorization performs checks against law enforcement databases. All travelers seeking admission to the United States under the Visa Waiver Program are required to obtain an electronic travel authorization using this system prior to being granted boarding.

If your electronic travel authorization application is approved, it establishes that you are eligible to travel, but does not establish that you are admissible to the United States under the Visa Waiver Program. Upon arrival to the United States, you will be inspected by a U.S. Customs and Border Protection Officer at a port of entry who may determine that you are inadmissible under the Visa Waiver Program or for any reason under United States law.

A determination that you are not eligible for electronic travel authorization does not preclude you from applying for a visa to travel to the United States.

All information provided by you, or on your behalf by a designated third party, must be true and correct. An electronic travel authorization may be revoked at any time and for any reason, such as new information influencing eligibility. You may be subject to administrative or criminal penalties if you knowingly and willfully make a materially false, fictitious, or fraudulent statement or representation in an electronic travel authorization application submitted by you or on your behalf.

WARNING: If upon application for admission to the United States at a port of entry you are admitted under the Visa Waiver Program (VWP) by a US Customs and Border Protection Officer, you may not accept unauthorized employment; or attend school; or represent the foreign information media during your visit under the program. You may not apply for:

1) a change of nonimmigrant status,

2) an extension of stay, or

3) adjustment of status to temporary or permanent resident, unless eligible under section 245(c)(4) of the Immigration and Nationality Act.

Violation of these terms will subject you to REMOVAL.

Please indicate you have read and understand the information provided above:

 

 

 

 

 

WAIVER OF RIGHTS

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.

 

CERTIFICATION

 

 

       

VISA BASE TERMS & CONDITIONS (click to view)

 

 

If the form does not submit when you press the button below, please check you've answered all of the questions. Any you've missed or left out will be highlighted in red.

 

If you have paid for more than one ESTA and need to complete additional forms for other travellers in your party, please click the 'submit' button below, then follow the link in the success message.