ESTA出願
1
申請者情報を入力
2
Travel Information
3
Payment Information
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申請者／パスポート情報
あなたのパスポートを参照し、この同様のフォームにすべての情報を入力してください。
姓
*
名（下の名前）
*
性別
*
男性
女性
他の名前または別称を通用していますか?
*
はい
いいえ
Name or Alias
姓
*
名（下の名前）
*
生年月日
日
*
日
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
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23
24
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30
31
月
*
月
January
February
March
April
May
June
July
August
September
October
November
December
年
*
年
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
出生した市区町村名
*
出生国
*
出生国
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
パスポート番号
*
国籍
*
国籍
ANDORRA (AND)
AUSTRALIA (AUS)
AUSTRIA (AUT)
BELGIUM (BEL)
BRUNEI (BRN)
CHILE (CHL)
CZECH REPUBLIC (CZE)
DENMARK (DNK)
ESTONIA (EST)
FINLAND (FIN)
FRANCE (FRA)
GERMANY (DEU)
GREECE (GRC)
HUNGARY (HUN)
ICELAND (ISL)
IRELAND (IRL)
ITALY (ITA)
JAPAN (JPN)
LATVIA (LVA)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MALTA (MLT)
MONACO (MCO)
NETHERLANDS (NLD)
NEW ZEALAND (NZL)
NORWAY (NOR)
PORTUGAL (PRT)
SAN MARINO (SMR)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOUTH KOREA (KOR)
SPAIN (ESP)
SWEDEN (SWE)
SWITZERLAND (CHE)
TAIWAN (TWN)
UK - BRITISH CITIZEN (GBR)
UK - BRITISH DTC (GBD)
UK - BRITISH NATIONAL (O) (GBN)
UK - BRITISH OVERSEAS (GBO)
UK - BRITISH SUBJECT (GBS)
UK - PROTECTED PERSON (GBP)
国民識別番号
*
発行した国
*
国
ANDORRA (AND)
AUSTRALIA (AUS)
AUSTRIA (AUT)
BELGIUM (BEL)
BRUNEI (BRN)
CHILE (CHL)
CZECH REPUBLIC (CZE)
DENMARK (DNK)
ESTONIA (EST)
FINLAND (FIN)
FRANCE (FRA)
GERMANY (DEU)
GREECE (GRC)
HUNGARY (HUN)
ICELAND (ISL)
IRELAND (IRL)
ITALY (ITA)
JAPAN (JPN)
LATVIA (LVA)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MALTA (MLT)
MONACO (MCO)
NETHERLANDS (NLD)
NEW ZEALAND (NZL)
NORWAY (NOR)
PORTUGAL (PRT)
SAN MARINO (SMR)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOUTH KOREA (KOR)
SPAIN (ESP)
SWEDEN (SWE)
SWITZERLAND (CHE)
TAIWAN (TWN)
UK - BRITISH CITIZEN (GBR)
UK - BRITISH DTC (GBD)
UK - BRITISH NATIONAL (O) (GBN)
UK - BRITISH OVERSEAS (GBO)
UK - BRITISH SUBJECT (GBS)
UK - PROTECTED PERSON (GBP)
個人識別番号
*
発行日
日
*
日
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
月
*
月
January
February
March
April
May
June
July
August
September
October
November
December
年
*
年
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
有効期限
日
*
日
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
月
*
月
January
February
March
April
May
June
July
August
September
October
November
December
年
*
年
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
どこか他の国から、これまでに渡航用のパスポートまたは国家身分証明書を発給されたことはありますか？
*
もしどこか他の国から、これらの文書のいずれも発給されていない場合は、この質問に対し「NO」と回答してください。他国からこれらの文書を一通発給されたものの、そのバスポート番号あるいは国家身分証明書の番号および有効期限年を思い出せない場合は、パスポート番号欄に 「UNKNOWN」（不明）と回答し、有効期限年欄に数字の「0」を4桁「0000」と入力してください。
はい
いいえ
発行した国
*
国
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
文書の種類
*
パスポート番号
National Identity Card Number
文書番号
*
有効期限
*
別の市民権・国籍
今現在、あなたはどこか他の国の市民あるいは国民ですか？
*
はい
いいえ
市民権・国籍
*
国
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
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その他
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これまでにどこか他の国の市民または国民だったことはありますか？
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市民権・国籍
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国
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
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国
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
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国番号
国番号
AFGHANISTAN (AFG) (+93)
ALAND ISLANDS (ALA) (+358)
ALBANIA (ALB) (+355)
ALGERIA (DZA) (+213)
AMERICAN SAMOA (ASM) (+1)
ANDORRA (AND) (+376)
ANGOLA (AGO) (+244)
ANGUILLA (AIA) (+1)
ANTARCTICA (ATA) (+672)
ANTIGUA AND BARBUDA (ATG) (+1)
ARGENTINA (ARG) (+54)
ARMENIA (ARM) (+374)
ARUBA (ABW) (+297)
AUSTRALIA (AUS) (+61)
AUSTRIA (AUT) (+43)
AZERBAIJAN (AZE) (+994)
BAHAMAS (BHS) (+1)
BAHRAIN (BHR) (+973)
BANGLADESH (BGD) (+880)
BARBADOS (BRB) (+1)
BELARUS (BLR) (+375)
BELGIUM (BEL) (+32)
BELIZE (BLZ) (+501)
BENIN (BEN) (+229)
BERMUDA (BMU) (+1)
BHUTAN (BTN) (+975)
BOLIVIA (BOL) (+591)
BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)
BOSNIA AND HERZEGOVINA (BIH) (+387)
BOTSWANA (BWA) (+267)
BOUVET ISLAND (BVT) (+55)
BRAZIL (BRA) (+55)
BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)
BRUNEI (BRN) (+673)
BULGARIA (BGR) (+359)
BURKINA FASO (BFA) (+226)
BURMA (BUR) (+95)
BURUNDI (BDI) (+257)
CAMBODIA (KHM) (+855)
CAMEROON (CMR) (+237)
CANADA (CAN) (+1)
CANTON AND ENDERBURY ISLANDS (CTE) (+686)
CAPE VERDE (CPV) (+238)
CAYMAN ISLANDS (CYM) (+1)
CENTRAL AFRICAN REPUBLIC (CAF) (+236)
CHAD (TCD) (+235)
CHILE (CHL) (+56)
CHINA (CHN) (+86)
CHRISTMAS ISLAND (CXR) (+61)
COCOS (KEELING) ISLANDS (CCK) (+61)
COLOMBIA (COL) (+57)
COMOROS (COM) (+269)
CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)
CONGO, REPUBLIC OF (COG) (+242)
COOK ISLANDS (COK) (+682)
COSTA RICA (CRI) (+506)
COTE D'IVOIRE (CIV) (+225)
CROATIA (HRV) (+385)
CUBA (CUB) (+53)
CURACAO (CUW) (+599)
CYPRUS (CYP) (+357)
CZECH REPUBLIC (CZE) (+420)
DEMOCRATIC YEMEN (YMD) (+967)
DENMARK (DNK) (+45)
DJIBOUTI (DJI) (+253)
DOMINICA (DMA) (+1)
DOMINICAN REPUBLIC (DOM) (+1)
EAST TIMOR (TMP) (+670)
ECUADOR (ECU) (+593)
EGYPT (EGY) (+20)
EL SALVADOR (SLV) (+503)
EQUATORIAL GUINEA (GNQ) (+240)
ERITREA (ERI) (+291)
ESTONIA (EST) (+372)
ETHIOPIA (ETH) (+251)
FALKLAND ISLANDS (FLK) (+500)
FAROE ISLANDS (FRO) (+298)
FIJI (FJI) (+679)
FINLAND (FIN) (+358)
FRANCE (FRA) (+33)
FRANCE METROPOLITAN (FXX) (+33)
FRENCH GUIANA (GUF) (+594)
FRENCH POLYNESIA (PYF) (+689)
FRENCH SOUTHERN TERRITORIES (ATF) (+262)
GABON (GAB) (+241)
GAMBIA (GMB) (+220)
GEORGIA (GEO) (+995)
GERMANY (DEU) (+49)
GHANA (GHA) (+233)
GIBRALTAR (GIB) (+350)
GREECE (GRC) (+30)
GREENLAND (GRL) (+299)
GRENADA (GRD) (+1)
GUADELOUPE (GLP) (+590)
GUAM (GUM) (+1)
GUATEMALA (GTM) (+502)
GUERNSEY (GGY) (+44)
GUINEA (GIN) (+224)
GUINEA-BISSAU (GNB) (+245)
GUYANA (GUY) (+592)
HAITI (HTI) (+509)
HEARD AND MC DONALD ISLANDS (HMD) (+0)
HONDURAS (HND) (+504)
HONG KONG (HKG) (+852)
HUNGARY (HUN) (+36)
ICELAND (ISL) (+354)
INDIA (IND) (+91)
INDONESIA (IDN) (+62)
IRAN (IRN) (+98)
IRAQ (IRQ) (+964)
IRELAND (IRL) (+353)
ISLE OF MAN (IMN) (+44)
ISRAEL (ISR) (+972)
ITALY (ITA) (+39)
JAMAICA (JAM) (+1)
JAPAN (JPN) (+81)
JERSEY (JEY) (+44)
JOHNSTON ISLAND (JTN) (+1)
JORDAN (JOR) (+962)
KAZAKHSTAN (KAZ) (+7)
KENYA (KEN) (+254)
KIRIBATI (KIR) (+686)
KOSOVO (KVV) (+383)
KUWAIT (KWT) (+965)
KYRGYZSTAN (KGZ) (+996)
LAOS (LAO) (+856)
LATVIA (LVA) (+371)
LEBANON (LBN) (+961)
LESOTHO (LSO) (+266)
LIBERIA (LBR) (+231)
LIBYA (LBY) (+218)
LIECHTENSTEIN (LIE) (+423)
LITHUANIA (LTU) (+370)
LUXEMBOURG (LUX) (+352)
MACAU (MAC) (+853)
MACEDONIA (MKD) (+389)
MADAGASCAR (MDG) (+261)
MALAWI (MWI) (+265)
MALAYSIA (MYS) (+60)
MALDIVES (MDV) (+960)
MALI (MLI) (+223)
MALTA (MLT) (+356)
MARSHALL ISLANDS (MHL) (+692)
MARTINIQUE (MTQ) (+596)
MAURITANIA (MRT) (+222)
MAURITIUS (MUS) (+230)
MAYOTTE (MYT) (+262)
MEXICO (MEX) (+52)
MICRONESIA - FEDERATED STATES OF (FSM) (+691)
MIDWAY ISLANDS (MID) (+1)
MOLDOVA (MDA) (+373)
MONACO (MCO) (+377)
MONGOLIA (MNG) (+976)
MONTENEGRO (MNE) (+382)
MONTSERRAT (MSR) (+1)
MOROCCO (MAR) (+212)
MOZAMBIQUE (MOZ) (+258)
MYANMAR (MMR) (+95)
NAMIBIA (NAM) (+264)
NAURU (NRU) (+674)
NEPAL (NPL) (+977)
NETHERLANDS (NLD) (+31)
NETHERLANDS ANTILLES (ANT) (+599)
NEW CALEDONIA (NCL) (+687)
NEW ZEALAND (NZL) (+64)
NICARAGUA (NIC) (+505)
NIGER (NER) (+227)
NIGERIA (NGA) (+234)
NIUE (NIU) (+683)
NORFOLK ISLAND (NFK) (+672)
NORTH KOREA (PRK) (+850)
NORTHERN MARIANA ISLANDS (MNP) (+1)
NORWAY (NOR) (+47)
OMAN (OMN) (+968)
PAKISTAN (PAK) (+92)
PALAU (PLW) (+680)
PALESTINIAN TERRITORIES (PSE) (+970)
PANAMA (PAN) (+507)
PAPUA NEW GUINEA (PNG) (+675)
PARAGUAY (PRY) (+595)
PERU (PER) (+51)
PHILIPPINES (PHL) (+63)
PITCAIRN ISLANDS (PCN) (+64)
POLAND (POL) (+48)
PORTUGAL (PRT) (+351)
PUERTO RICO (PRI) (+1)
QATAR (QAT) (+974)
REUNION (REU) (+262)
ROMANIA (ROM) (+40)
RUSSIA (RUS) (+7)
RWANDA (RWA) (+250)
SAINT BARTHELEMY (BLM) (+590)
SAINT KITTS AND NEVIS (KNA) (+1)
SAINT LUCIA (LCA) (+1)
SAINT MARTIN (FRENCH PART) (MAF) (+590)
SAINT VINCENT AND THE GRENADINES (VCT) (+1)
SAMOA (WSM) (+685)
SAN MARINO (SMR) (+378)
SAO TOME AND PRINCIPE (STP) (+239)
SAUDI ARABIA (SAU) (+966)
SENEGAL (SEN) (+221)
SERBIA (SRB) (+381)
SERBIA AND MONTENEGRO (SCG) (+381)
SEYCHELLES (SYC) (+248)
SIERRA LEONE (SLE) (+232)
SINGAPORE (SGP) (+65)
SINT MAARTEN (DUTCH PART) (SXM) (+1)
SLOVAKIA (SVK) (+421)
SLOVENIA (SVN) (+386)
SOLOMON ISLANDS (SLB) (+677)
SOMALIA (SOM) (+252)
SOUTH AFRICA (ZAF) (+27)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)
SOUTH KOREA (KOR) (+82)
SOUTH SUDAN (SSD) (+211)
SPAIN (ESP) (+34)
SRI LANKA (LKA) (+94)
ST. HELENA (SHN) (+290)
ST. PIERRE AND MIQUELON (SPM) (+508)
SUDAN (SDN) (+249)
SURINAME (SUR) (+597)
SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)
SWAZILAND (SWZ) (+268)
SWEDEN (SWE) (+46)
SWITZERLAND (CHE) (+41)
SYRIA (SYR) (+963)
TAIWAN (TWN) (+886)
TAJIKISTAN (TJK) (+992)
TANZANIA (TZA) (+255)
THAILAND (THA) (+66)
TIMOR-LESTE (TLS) (+670)
TOGO (TGO) (+228)
TOKELAU (TKL) (+690)
TONGA (TON) (+676)
TRINIDAD AND TOBAGO (TTO) (+1)
TUNISIA (TUN) (+216)
TURKEY (TUR) (+90)
TURKMENISTAN (TKM) (+993)
TURKS AND CAICOS ISLANDS (TCA) (+1)
TUVALU (TUV) (+688)
UGANDA (UGA) (+256)
UKRAINE (UKR) (+380)
UNITED ARAB EMIRATES (ARE) (+971)
UNITED KINGDOM (GBR) (+44)
UNITED STATES (USA) (+1)
UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)
URUGUAY (URY) (+598)
UZBEKISTAN (UZB) (+998)
VANUATU (VUT) (+678)
VATICAN CITY STATE (HOLY SEE) (VAT) (+379)
VENEZUELA (VEN) (+58)
VIETNAM (VNM) (+84)
VIRGIN ISLANDS (BRITISH) (VGB) (+1)
VIRGIN ISLANDS (U.S.) (VIR) (+1)
WAKE ISLAND (WAK) (+808)
WALLIS AND FUTUNA ISLANDS (WLF) (+681)
WESTERN SAHARA (ESH) (+212)
YEMEN (YEM) (+967)
ZAIRE (ZAR) (+243)
ZAMBIA (ZMB) (+260)
ZIMBABWE (ZWE) (+263)
電話番号
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ソーシャルメディア（オプション）
オンラインサービス利用時の使用環境情報を入力してください。
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JustPaste.it
LinkedIn
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Other Platform / Provider
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ソーシャルメディアの名称
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ユーザーネーム、ハンドル名、スクリーンネームまたは利用中のソーシャルメディアプロファイルに関わるあなたを特定する呼び名のすべてを入力してください。
勤務先情報
現在または過去に勤務経験がありますか？
*
はい
いいえ
雇用主名
*
ホームアドレスライン1
*
ホームアドレスライン2
市区町村
*
州／都道府県／地方
*
国
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国
AFGHANISTAN (AFG)
ALAND ISLANDS (ALA)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BONAIRE, SINT EUSTATIUS AND SABA (BES)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (GYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO, DEMOCRATIC REPUBLIC OF (COD)
CONGO, REPUBLIC OF (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D'IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CURACAO (CUW)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLY)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
EHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FARCE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUERNSEY (GGY)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMO)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (ION)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISLE OF MAN (IMN)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JERSEY (JEY)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSD)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTENEGRO (MNE)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT BARTHELEMY (BLM)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT MARTIN (FRENCH PART) (MAF)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SINT MAARTEN (DUTCH PART) (SXM)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SOUTH SUDAN (SSD)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SON)
SVALBARD AND JAN MAVEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
米国への渡航目的は、他国へ乗り継ぐためですか?
*
はい
いいえ
米国内の連絡先情報
米国内での連絡先として、友人、親戚、または勤務先同僚が該当します。もし米国内での連絡先がない場合は、滞在予定先の名前、住所、および電話番号を入力して下さい（例、ホテル等）。または、UNKNOWNと入力することもできます。
名
*
ホームアドレスライン1
*
ホームアドレスライン2
アパートメントの部屋番号
市区町村
*
都道府県
*
この「州」欄では、州名を選択して下さい。この州は、申請上の入力必須項目です。またはUNKNOWNを選択することもできます。
都道府県
ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NESRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
NORTH MARIANA ISL
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
UNKNOWN
国番号
*
AFGHANISTAN (AFG) (+93)
ALAND ISLANDS (ALA) (+358)
ALBANIA (ALB) (+355)
ALGERIA (DZA) (+213)
AMERICAN SAMOA (ASM) (+1)
ANDORRA (AND) (+376)
ANGOLA (AGO) (+244)
ANGUILLA (AIA) (+1)
ANTARCTICA (ATA) (+672)
ANTIGUA AND BARBUDA (ATG) (+1)
ARGENTINA (ARG) (+54)
ARMENIA (ARM) (+374)
ARUBA (ABW) (+297)
AUSTRALIA (AUS) (+61)
AUSTRIA (AUT) (+43)
AZERBAIJAN (AZE) (+994)
BAHAMAS (BHS) (+1)
BAHRAIN (BHR) (+973)
BANGLADESH (BGD) (+880)
BARBADOS (BRB) (+1)
BELARUS (BLR) (+375)
BELGIUM (BEL) (+32)
BELIZE (BLZ) (+501)
BENIN (BEN) (+229)
BERMUDA (BMU) (+1)
BHUTAN (BTN) (+975)
BOLIVIA (BOL) (+591)
BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)
BOSNIA AND HERZEGOVINA (BIH) (+387)
BOTSWANA (BWA) (+267)
BOUVET ISLAND (BVT) (+55)
BRAZIL (BRA) (+55)
BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)
BRUNEI (BRN) (+673)
BULGARIA (BGR) (+359)
BURKINA FASO (BFA) (+226)
BURMA (BUR) (+95)
BURUNDI (BDI) (+257)
CAMBODIA (KHM) (+855)
CAMEROON (CMR) (+237)
CANADA (CAN) (+1)
CANTON AND ENDERBURY ISLANDS (CTE) (+686)
CAPE VERDE (CPV) (+238)
CAYMAN ISLANDS (CYM) (+1)
CENTRAL AFRICAN REPUBLIC (CAF) (+236)
CHAD (TCD) (+235)
CHILE (CHL) (+56)
CHINA (CHN) (+86)
CHRISTMAS ISLAND (CXR) (+61)
COCOS (KEELING) ISLANDS (CCK) (+61)
COLOMBIA (COL) (+57)
COMOROS (COM) (+269)
CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)
CONGO, REPUBLIC OF (COG) (+242)
COOK ISLANDS (COK) (+682)
COSTA RICA (CRI) (+506)
COTE D'IVOIRE (CIV) (+225)
CROATIA (HRV) (+385)
CUBA (CUB) (+53)
CURACAO (CUW) (+599)
CYPRUS (CYP) (+357)
CZECH REPUBLIC (CZE) (+420)
DEMOCRATIC YEMEN (YMD) (+967)
DENMARK (DNK) (+45)
DJIBOUTI (DJI) (+253)
DOMINICA (DMA) (+1)
DOMINICAN REPUBLIC (DOM) (+1)
EAST TIMOR (TMP) (+670)
ECUADOR (ECU) (+593)
EGYPT (EGY) (+20)
EL SALVADOR (SLV) (+503)
EQUATORIAL GUINEA (GNQ) (+240)
ERITREA (ERI) (+291)
ESTONIA (EST) (+372)
ETHIOPIA (ETH) (+251)
FALKLAND ISLANDS (FLK) (+500)
FAROE ISLANDS (FRO) (+298)
FIJI (FJI) (+679)
FINLAND (FIN) (+358)
FRANCE (FRA) (+33)
FRANCE METROPOLITAN (FXX) (+33)
FRENCH GUIANA (GUF) (+594)
FRENCH POLYNESIA (PYF) (+689)
FRENCH SOUTHERN TERRITORIES (ATF) (+262)
GABON (GAB) (+241)
GAMBIA (GMB) (+220)
GEORGIA (GEO) (+995)
GERMANY (DEU) (+49)
GHANA (GHA) (+233)
GIBRALTAR (GIB) (+350)
GREECE (GRC) (+30)
GREENLAND (GRL) (+299)
GRENADA (GRD) (+1)
GUADELOUPE (GLP) (+590)
GUAM (GUM) (+1)
GUATEMALA (GTM) (+502)
GUERNSEY (GGY) (+44)
GUINEA (GIN) (+224)
GUINEA-BISSAU (GNB) (+245)
GUYANA (GUY) (+592)
HAITI (HTI) (+509)
HEARD AND MC DONALD ISLANDS (HMD) (+0)
HONDURAS (HND) (+504)
HONG KONG (HKG) (+852)
HUNGARY (HUN) (+36)
ICELAND (ISL) (+354)
INDIA (IND) (+91)
INDONESIA (IDN) (+62)
IRAN (IRN) (+98)
IRAQ (IRQ) (+964)
IRELAND (IRL) (+353)
ISLE OF MAN (IMN) (+44)
ISRAEL (ISR) (+972)
ITALY (ITA) (+39)
JAMAICA (JAM) (+1)
JAPAN (JPN) (+81)
JERSEY (JEY) (+44)
JOHNSTON ISLAND (JTN) (+1)
JORDAN (JOR) (+962)
KAZAKHSTAN (KAZ) (+7)
KENYA (KEN) (+254)
KIRIBATI (KIR) (+686)
KOSOVO (KVV) (+383)
KUWAIT (KWT) (+965)
KYRGYZSTAN (KGZ) (+996)
LAOS (LAO) (+856)
LATVIA (LVA) (+371)
LEBANON (LBN) (+961)
LESOTHO (LSO) (+266)
LIBERIA (LBR) (+231)
LIBYA (LBY) (+218)
LIECHTENSTEIN (LIE) (+423)
LITHUANIA (LTU) (+370)
LUXEMBOURG (LUX) (+352)
MACAU (MAC) (+853)
MACEDONIA (MKD) (+389)
MADAGASCAR (MDG) (+261)
MALAWI (MWI) (+265)
MALAYSIA (MYS) (+60)
MALDIVES (MDV) (+960)
MALI (MLI) (+223)
MALTA (MLT) (+356)
MARSHALL ISLANDS (MHL) (+692)
MARTINIQUE (MTQ) (+596)
MAURITANIA (MRT) (+222)
MAURITIUS (MUS) (+230)
MAYOTTE (MYT) (+262)
MEXICO (MEX) (+52)
MICRONESIA - FEDERATED STATES OF (FSM) (+691)
MIDWAY ISLANDS (MID) (+1)
MOLDOVA (MDA) (+373)
MONACO (MCO) (+377)
MONGOLIA (MNG) (+976)
MONTENEGRO (MNE) (+382)
MONTSERRAT (MSR) (+1)
MOROCCO (MAR) (+212)
MOZAMBIQUE (MOZ) (+258)
MYANMAR (MMR) (+95)
NAMIBIA (NAM) (+264)
NAURU (NRU) (+674)
NEPAL (NPL) (+977)
NETHERLANDS (NLD) (+31)
NETHERLANDS ANTILLES (ANT) (+599)
NEW CALEDONIA (NCL) (+687)
NEW ZEALAND (NZL) (+64)
NICARAGUA (NIC) (+505)
NIGER (NER) (+227)
NIGERIA (NGA) (+234)
NIUE (NIU) (+683)
NORFOLK ISLAND (NFK) (+672)
NORTH KOREA (PRK) (+850)
NORTHERN MARIANA ISLANDS (MNP) (+1)
NORWAY (NOR) (+47)
OMAN (OMN) (+968)
PAKISTAN (PAK) (+92)
PALAU (PLW) (+680)
PALESTINIAN TERRITORIES (PSE) (+970)
PANAMA (PAN) (+507)
PAPUA NEW GUINEA (PNG) (+675)
PARAGUAY (PRY) (+595)
PERU (PER) (+51)
PHILIPPINES (PHL) (+63)
PITCAIRN ISLANDS (PCN) (+64)
POLAND (POL) (+48)
PORTUGAL (PRT) (+351)
PUERTO RICO (PRI) (+1)
QATAR (QAT) (+974)
REUNION (REU) (+262)
ROMANIA (ROM) (+40)
RUSSIA (RUS) (+7)
RWANDA (RWA) (+250)
SAINT BARTHELEMY (BLM) (+590)
SAINT KITTS AND NEVIS (KNA) (+1)
SAINT LUCIA (LCA) (+1)
SAINT MARTIN (FRENCH PART) (MAF) (+590)
SAINT VINCENT AND THE GRENADINES (VCT) (+1)
SAMOA (WSM) (+685)
SAN MARINO (SMR) (+378)
SAO TOME AND PRINCIPE (STP) (+239)
SAUDI ARABIA (SAU) (+966)
SENEGAL (SEN) (+221)
SERBIA (SRB) (+381)
SERBIA AND MONTENEGRO (SCG) (+381)
SEYCHELLES (SYC) (+248)
SIERRA LEONE (SLE) (+232)
SINGAPORE (SGP) (+65)
SINT MAARTEN (DUTCH PART) (SXM) (+1)
SLOVAKIA (SVK) (+421)
SLOVENIA (SVN) (+386)
SOLOMON ISLANDS (SLB) (+677)
SOMALIA (SOM) (+252)
SOUTH AFRICA (ZAF) (+27)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)
SOUTH KOREA (KOR) (+82)
SOUTH SUDAN (SSD) (+211)
SPAIN (ESP) (+34)
SRI LANKA (LKA) (+94)
ST. HELENA (SHN) (+290)
ST. PIERRE AND MIQUELON (SPM) (+508)
SUDAN (SDN) (+249)
SURINAME (SUR) (+597)
SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)
SWAZILAND (SWZ) (+268)
SWEDEN (SWE) (+46)
SWITZERLAND (CHE) (+41)
SYRIA (SYR) (+963)
TAIWAN (TWN) (+886)
TAJIKISTAN (TJK) (+992)
TANZANIA (TZA) (+255)
THAILAND (THA) (+66)
TIMOR-LESTE (TLS) (+670)
TOGO (TGO) (+228)
TOKELAU (TKL) (+690)
TONGA (TON) (+676)
TRINIDAD AND TOBAGO (TTO) (+1)
TUNISIA (TUN) (+216)
TURKEY (TUR) (+90)
TURKMENISTAN (TKM) (+993)
TURKS AND CAICOS ISLANDS (TCA) (+1)
TUVALU (TUV) (+688)
UGANDA (UGA) (+256)
UKRAINE (UKR) (+380)
UNITED ARAB EMIRATES (ARE) (+971)
UNITED KINGDOM (GBR) (+44)
UNITED STATES (USA) (+1)
UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)
URUGUAY (URY) (+598)
UZBEKISTAN (UZB) (+998)
VANUATU (VUT) (+678)
VATICAN CITY STATE (HOLY SEE) (VAT) (+379)
VENEZUELA (VEN) (+58)
VIETNAM (VNM) (+84)
VIRGIN ISLANDS (BRITISH) (VGB) (+1)
VIRGIN ISLANDS (U.S.) (VIR) (+1)
WAKE ISLAND (WAK) (+808)
WALLIS AND FUTUNA ISLANDS (WLF) (+681)
WESTERN SAHARA (ESH) (+212)
YEMEN (YEM) (+967)
ZAIRE (ZAR) (+243)
ZAMBIA (ZMB) (+260)
ZIMBABWE (ZWE) (+263)
電話
*
あなたの米国での連絡先電話番号を入力して下さい。電話番号は、申請上の入力必須項目です。連絡先の電話番号がわからない場合は、数字の〇をいくつか入力して下さい。
米国内および米国以外の緊急連絡先情報
緊急連絡先として、米国以外に在住する家族、友人、または勤務先同僚などの連絡先を入力して下さい。この「姓」欄には、緊急連絡先である人の姓を入力してください。申請上、この欄への入力は必須です。もし緊急連絡先がない場合は、UNKNOWNと入力して下さい。
姓
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名（下の名前）
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電子メールアドレス
*
国番号
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国番号
AFGHANISTAN (AFG) (+93)
ALAND ISLANDS (ALA) (+358)
ALBANIA (ALB) (+355)
ALGERIA (DZA) (+213)
AMERICAN SAMOA (ASM) (+1)
ANDORRA (AND) (+376)
ANGOLA (AGO) (+244)
ANGUILLA (AIA) (+1)
ANTARCTICA (ATA) (+672)
ANTIGUA AND BARBUDA (ATG) (+1)
ARGENTINA (ARG) (+54)
ARMENIA (ARM) (+374)
ARUBA (ABW) (+297)
AUSTRALIA (AUS) (+61)
AUSTRIA (AUT) (+43)
AZERBAIJAN (AZE) (+994)
BAHAMAS (BHS) (+1)
BAHRAIN (BHR) (+973)
BANGLADESH (BGD) (+880)
BARBADOS (BRB) (+1)
BELARUS (BLR) (+375)
BELGIUM (BEL) (+32)
BELIZE (BLZ) (+501)
BENIN (BEN) (+229)
BERMUDA (BMU) (+1)
BHUTAN (BTN) (+975)
BOLIVIA (BOL) (+591)
BONAIRE, SINT EUSTATIUS AND SABA (BES) (+599)
BOSNIA AND HERZEGOVINA (BIH) (+387)
BOTSWANA (BWA) (+267)
BOUVET ISLAND (BVT) (+55)
BRAZIL (BRA) (+55)
BRITISH INDIAN OCEAN TERRITORY (IOT) (+246)
BRUNEI (BRN) (+673)
BULGARIA (BGR) (+359)
BURKINA FASO (BFA) (+226)
BURMA (BUR) (+95)
BURUNDI (BDI) (+257)
CAMBODIA (KHM) (+855)
CAMEROON (CMR) (+237)
CANADA (CAN) (+1)
CANTON AND ENDERBURY ISLANDS (CTE) (+686)
CAPE VERDE (CPV) (+238)
CAYMAN ISLANDS (CYM) (+1)
CENTRAL AFRICAN REPUBLIC (CAF) (+236)
CHAD (TCD) (+235)
CHILE (CHL) (+56)
CHINA (CHN) (+86)
CHRISTMAS ISLAND (CXR) (+61)
COCOS (KEELING) ISLANDS (CCK) (+61)
COLOMBIA (COL) (+57)
COMOROS (COM) (+269)
CONGO, DEMOCRATIC REPUBLIC OF (COD) (+243)
CONGO, REPUBLIC OF (COG) (+242)
COOK ISLANDS (COK) (+682)
COSTA RICA (CRI) (+506)
COTE D'IVOIRE (CIV) (+225)
CROATIA (HRV) (+385)
CUBA (CUB) (+53)
CURACAO (CUW) (+599)
CYPRUS (CYP) (+357)
CZECH REPUBLIC (CZE) (+420)
DEMOCRATIC YEMEN (YMD) (+967)
DENMARK (DNK) (+45)
DJIBOUTI (DJI) (+253)
DOMINICA (DMA) (+1)
DOMINICAN REPUBLIC (DOM) (+1)
EAST TIMOR (TMP) (+670)
ECUADOR (ECU) (+593)
EGYPT (EGY) (+20)
EL SALVADOR (SLV) (+503)
EQUATORIAL GUINEA (GNQ) (+240)
ERITREA (ERI) (+291)
ESTONIA (EST) (+372)
ETHIOPIA (ETH) (+251)
FALKLAND ISLANDS (FLK) (+500)
FAROE ISLANDS (FRO) (+298)
FIJI (FJI) (+679)
FINLAND (FIN) (+358)
FRANCE (FRA) (+33)
FRANCE METROPOLITAN (FXX) (+33)
FRENCH GUIANA (GUF) (+594)
FRENCH POLYNESIA (PYF) (+689)
FRENCH SOUTHERN TERRITORIES (ATF) (+262)
GABON (GAB) (+241)
GAMBIA (GMB) (+220)
GEORGIA (GEO) (+995)
GERMANY (DEU) (+49)
GHANA (GHA) (+233)
GIBRALTAR (GIB) (+350)
GREECE (GRC) (+30)
GREENLAND (GRL) (+299)
GRENADA (GRD) (+1)
GUADELOUPE (GLP) (+590)
GUAM (GUM) (+1)
GUATEMALA (GTM) (+502)
GUERNSEY (GGY) (+44)
GUINEA (GIN) (+224)
GUINEA-BISSAU (GNB) (+245)
GUYANA (GUY) (+592)
HAITI (HTI) (+509)
HEARD AND MC DONALD ISLANDS (HMD) (+0)
HONDURAS (HND) (+504)
HONG KONG (HKG) (+852)
HUNGARY (HUN) (+36)
ICELAND (ISL) (+354)
INDIA (IND) (+91)
INDONESIA (IDN) (+62)
IRAN (IRN) (+98)
IRAQ (IRQ) (+964)
IRELAND (IRL) (+353)
ISLE OF MAN (IMN) (+44)
ISRAEL (ISR) (+972)
ITALY (ITA) (+39)
JAMAICA (JAM) (+1)
JAPAN (JPN) (+81)
JERSEY (JEY) (+44)
JOHNSTON ISLAND (JTN) (+1)
JORDAN (JOR) (+962)
KAZAKHSTAN (KAZ) (+7)
KENYA (KEN) (+254)
KIRIBATI (KIR) (+686)
KOSOVO (KVV) (+383)
KUWAIT (KWT) (+965)
KYRGYZSTAN (KGZ) (+996)
LAOS (LAO) (+856)
LATVIA (LVA) (+371)
LEBANON (LBN) (+961)
LESOTHO (LSO) (+266)
LIBERIA (LBR) (+231)
LIBYA (LBY) (+218)
LIECHTENSTEIN (LIE) (+423)
LITHUANIA (LTU) (+370)
LUXEMBOURG (LUX) (+352)
MACAU (MAC) (+853)
MACEDONIA (MKD) (+389)
MADAGASCAR (MDG) (+261)
MALAWI (MWI) (+265)
MALAYSIA (MYS) (+60)
MALDIVES (MDV) (+960)
MALI (MLI) (+223)
MALTA (MLT) (+356)
MARSHALL ISLANDS (MHL) (+692)
MARTINIQUE (MTQ) (+596)
MAURITANIA (MRT) (+222)
MAURITIUS (MUS) (+230)
MAYOTTE (MYT) (+262)
MEXICO (MEX) (+52)
MICRONESIA - FEDERATED STATES OF (FSM) (+691)
MIDWAY ISLANDS (MID) (+1)
MOLDOVA (MDA) (+373)
MONACO (MCO) (+377)
MONGOLIA (MNG) (+976)
MONTENEGRO (MNE) (+382)
MONTSERRAT (MSR) (+1)
MOROCCO (MAR) (+212)
MOZAMBIQUE (MOZ) (+258)
MYANMAR (MMR) (+95)
NAMIBIA (NAM) (+264)
NAURU (NRU) (+674)
NEPAL (NPL) (+977)
NETHERLANDS (NLD) (+31)
NETHERLANDS ANTILLES (ANT) (+599)
NEW CALEDONIA (NCL) (+687)
NEW ZEALAND (NZL) (+64)
NICARAGUA (NIC) (+505)
NIGER (NER) (+227)
NIGERIA (NGA) (+234)
NIUE (NIU) (+683)
NORFOLK ISLAND (NFK) (+672)
NORTH KOREA (PRK) (+850)
NORTHERN MARIANA ISLANDS (MNP) (+1)
NORWAY (NOR) (+47)
OMAN (OMN) (+968)
PAKISTAN (PAK) (+92)
PALAU (PLW) (+680)
PALESTINIAN TERRITORIES (PSE) (+970)
PANAMA (PAN) (+507)
PAPUA NEW GUINEA (PNG) (+675)
PARAGUAY (PRY) (+595)
PERU (PER) (+51)
PHILIPPINES (PHL) (+63)
PITCAIRN ISLANDS (PCN) (+64)
POLAND (POL) (+48)
PORTUGAL (PRT) (+351)
PUERTO RICO (PRI) (+1)
QATAR (QAT) (+974)
REUNION (REU) (+262)
ROMANIA (ROM) (+40)
RUSSIA (RUS) (+7)
RWANDA (RWA) (+250)
SAINT BARTHELEMY (BLM) (+590)
SAINT KITTS AND NEVIS (KNA) (+1)
SAINT LUCIA (LCA) (+1)
SAINT MARTIN (FRENCH PART) (MAF) (+590)
SAINT VINCENT AND THE GRENADINES (VCT) (+1)
SAMOA (WSM) (+685)
SAN MARINO (SMR) (+378)
SAO TOME AND PRINCIPE (STP) (+239)
SAUDI ARABIA (SAU) (+966)
SENEGAL (SEN) (+221)
SERBIA (SRB) (+381)
SERBIA AND MONTENEGRO (SCG) (+381)
SEYCHELLES (SYC) (+248)
SIERRA LEONE (SLE) (+232)
SINGAPORE (SGP) (+65)
SINT MAARTEN (DUTCH PART) (SXM) (+1)
SLOVAKIA (SVK) (+421)
SLOVENIA (SVN) (+386)
SOLOMON ISLANDS (SLB) (+677)
SOMALIA (SOM) (+252)
SOUTH AFRICA (ZAF) (+27)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) (+500)
SOUTH KOREA (KOR) (+82)
SOUTH SUDAN (SSD) (+211)
SPAIN (ESP) (+34)
SRI LANKA (LKA) (+94)
ST. HELENA (SHN) (+290)
ST. PIERRE AND MIQUELON (SPM) (+508)
SUDAN (SDN) (+249)
SURINAME (SUR) (+597)
SVALBARD AND JAN MAYEN ISLANDS (SJM) (+47)
SWAZILAND (SWZ) (+268)
SWEDEN (SWE) (+46)
SWITZERLAND (CHE) (+41)
SYRIA (SYR) (+963)
TAIWAN (TWN) (+886)
TAJIKISTAN (TJK) (+992)
TANZANIA (TZA) (+255)
THAILAND (THA) (+66)
TIMOR-LESTE (TLS) (+670)
TOGO (TGO) (+228)
TOKELAU (TKL) (+690)
TONGA (TON) (+676)
TRINIDAD AND TOBAGO (TTO) (+1)
TUNISIA (TUN) (+216)
TURKEY (TUR) (+90)
TURKMENISTAN (TKM) (+993)
TURKS AND CAICOS ISLANDS (TCA) (+1)
TUVALU (TUV) (+688)
UGANDA (UGA) (+256)
UKRAINE (UKR) (+380)
UNITED ARAB EMIRATES (ARE) (+971)
UNITED KINGDOM (GBR) (+44)
UNITED STATES (USA) (+1)
UNITED STATES MINOR OUTLYING ISLANDS (UMI) (+1)
URUGUAY (URY) (+598)
UZBEKISTAN (UZB) (+998)
VANUATU (VUT) (+678)
VATICAN CITY STATE (HOLY SEE) (VAT) (+379)
VENEZUELA (VEN) (+58)
VIETNAM (VNM) (+84)
VIRGIN ISLANDS (BRITISH) (VGB) (+1)
VIRGIN ISLANDS (U.S.) (VIR) (+1)
WAKE ISLAND (WAK) (+808)
WALLIS AND FUTUNA ISLANDS (WLF) (+681)
WESTERN SAHARA (ESH) (+212)
YEMEN (YEM) (+967)
ZAIRE (ZAR) (+243)
ZAMBIA (ZMB) (+260)
ZIMBABWE (ZWE) (+263)
電話番号
*
緊急連絡先電話番号がない場合は、数字の〇をいくつか入力して下さい。
適格性についての質問
あなたは身体的あるいは精神的な疾患がありますか、あるいは薬物乱用者または依存症ですか、あるいは現在以下の疾病を患っていますか（伝染病についてはsection 361(b) of the Public Health Service Actに準じて規定されています）：
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コレラ ジフテリア 結核、感染症 疫病 天然痘 黄熱病r ウイルス性出血熱、エボラ熱、ラッサ熱、マールブルグ熱、クリミア・コンゴ熱を含む 重篤な急性呼吸器疾患は他者への伝染が可能で、死に至らしめる場合もあります
はい
いいえ
2) あなたはこれまでに、他者または政府当局に対して、所有物に甚大な損害を与えるか重大な危害を加えた結果、逮捕または有罪判決を受けたことがありますか？
*
はい
いいえ
3)あなたはこれまでに、違法薬物の所持、使用、または流通に関連するいずれの法規に違反したことがありますか？
*
はい
いいえ
4) あなたはテロ活動、スパイ行為、破壊工作、または集団虐殺に参画しようとしたり、あるいは参画したことがありますか？
*
はい
いいえ
5)あなたはこれまでに、あなた自身または他者用のビザを取得するため、あるいは米国に入国するため、詐欺行為または不正代理行為を犯したことはありますか？
*
はい
いいえ
6)あなたは現時点で、米国での就労を模索していますか、または過去に米国政府の許可なく、米国で雇用されていたことがありますか？
*
はい
いいえ
7)あなたはこれまでに、現在使用中あるいは過去に使用していたパスポートを用いて米国ビザを申請した際、否認されたことがありますか、あるいはこれまでに米国への入国を拒否、あるいは米国入国地での入国申請を取り消されたことがありますか？
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はい
いいえ
8)あなたはこれまでに、米国政府が許可した滞在許可期間を超過して、米国に滞在したことがありますか？
*
はい
いいえ
9) 2011年3月1日以降、イラク、シリア、イラン、スーダン、リビア、ソマリアまたはイエメンに渡航または滞在したことがありますか？
*
はい
いいえ
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