Application Form – ESTA-EVISA.COM

APPLICANT / PASSPORT INFORMATION

Refer to your passport and enter all information in the same format.

Important Notice: You may not use any special characters throughout this form.

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.

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*

Date of Birth

Day*

Month*

Year*

City of Birth*

Country of Birth*

Passport Number*

Please enter your passport number exactly as its stated in your passport. If you enter a wrong passport number, then your ESTA will NOT be valid.

Confirm your Passport Number*

Confirm your Passport Number. A wrong passport number will been that your ESTA is not valid. So please make sure that your Passport Number is correct.

National Identification Number*

Country of Citizenship*

Country of Citizenship (Nationality) as it appears on your Passport.

Issuing Country*

Country of Citizenship as it appears on your Passport.

Passport Issuance Date

Please choose your Passport's Date of Issue exactly as it appears in your Passport.

Day*

Month*

Year*

Passport Expiration Date

Please choose your Passport's Date of Expiry exactly as it appears in your Passport.

Day*

Month*

Year*

Other Citizenship/Nationality

Have you ever been issued a travel document by another country?*

Yes
No

Country*

Travel Document*

Passport Number
National Identity Card Number

Number of Document*

State the passport or document number of this travel document

Expiry Year*

Have you ever been issued a travel document by another country?*

Yes
No

Country of Citizenship*

How did you acquire citizenship / nationality from this country?*

Other*

State 'Other' reason.

Have you ever been a citizen or national of any other country?*

Yes
No

Citizenship*

From

Enter the date from which your previous citizenship started.

Day*

Month*

Year*

To

Enter the date your previous citizenship ended.

Day*

Month*

Year*

Email address

You will receive the response to your ESTA application at your email address. It is therefore important that you enter it correctly.

Email address*

Email Confirm email

Personal information

Are you known by other names or aliases?*

Yes
No

Other name/alias

Last name*

First name*

Contact details

Please enter your home address.

Address*

City*

State/Province/Region*

Country*

Phone Country Code*

Please choose your Phone Country Code.

Phone Number*

Do NOT enter "+" or "country code" in this field. You will also receive a text message by SMS with your ESTA application number on this phone number.

Parents

Parent 1 First Name*

Parent 1 Family Name*

Parent 2 First Name*

Parent 2 Family Name*

Employment

Do you have a current or former employer?*

Yes
No

Employer*

Address*

Enter the address of your workplace.

City*

State/Province/Region*

Country*

Travel Information

Is your trip to the US in transit to another country?*

Yes
No

Select Yes if you are traveling to the United States on your way to another country, e.g. if you stopover in the US as part of your flight.

Contact point in the United States

For example, your US contact point may be a friend, family member, or business associate. Otherwise you can specify the place you are going to stay overnight (eg your hotel). You can also type UNKNOWN instead.

Name*

Address*

City*

State*

Hidden

Landekode*

Hidden

Telefonnummer*

Skal angives uden landekode eller mellemrum. Hvis ikke du kender telefonnummeret kan du i stedet indtaste nuller.

Emergency contact

First name*

Family Name*

Email address for emergency contact*

Phone Country Code*

Phone Country Code of Emergency Contact.

Phone Number*

Do NOT enter "+" or "country code" in this field. Enter the phone number of your Emergency Contact.

APPLICANT / PASSPORT INFORMATION

Date of Birth

Passport Issuance Date

Passport Expiration Date

Other Citizenship/Nationality

From

To

Email address

Personal information

Other name/alias

Contact details

Parents

Employment

Travel Information

Contact point in the United States

Emergency contact

Payment

Pay & Receive your ESTA