ESTA Application Form

Enter Applicant Information

Please provide all responses in English.

Required fields are indicated by an asterisk *.

Applicant / Passport Information

Family Name*

First (Given) Name*

Gender*

Are you known by any other names or aliases?*

Alias

Family Name*

First (Given) Name*

Do you have another alias?*

No

Yes

Please Type any other alias you have*

Passport

Date of Birth*

City of Birth*

Country of Birth*

Passport Number*

Confirm Passport Number*

Country of Citizenship*

National Identification Number*

Personal Identification Number*

Passport Issuance Date*

Passport Expiration Date*

Passport Issuing Country*

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

Another Passport or National Identity

Issuing Country*

Document Type*

Document Number*

Expiration Year*

Add Another?*

No

Yes

Please Type any other Passport or National Identity you have*

Other Citizenship/Nationality

Are you now, a citizen or national of any other country?*

Citizenship/Nationality

Country of Citizenship / Nationality*

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

Other*

Add Another?*

No

Yes

Please Type any other Citizenship / Nationality you have*

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

Another Citizen

Country of Citizenship / Nationality*

Add Another?*

No

Yes

Please Type any other Citizen*

GE Membership

Are you a member of the CBP Global Entry Program?*

PASSID / Membership Number*

Parents

Please list your parents names in the boxes to the right. All applicants are required to fill out this section.

Family Name*

First (Given) Name*

Family Name*

First (Given) Name*

Your Contact Information

Address Line 1*

Address Line 2

Apartment Number

City*

State/Province/Region*

Country*

Telephone Type*

Country Code*

Phone*

E-mail Address*

Enter Email

Confirm E-mail Address*

Confirm Email

Social Media (Optional)

Please enter information associated with your online presence.

Social Media

Provider / Platform

Social Media Identifier*

Please Enter any other Platform and Social Media Identifier (Optional)

Employment Information

Do you have a current or previous employer?*

Employment Details

Job Title

Employer Name*

Address Line 1*

Address Line 2

City*

State/Province/Region*

Country*

Country Code*

Phone

USA ESTA Application Form

Enter Applicant Information

Applicant / Passport Information

Applicant / Passport Information

Alias

Passport

Another Passport or National Identity

Other Citizenship/Nationality

Citizenship/Nationality

Another Citizen

GE Membership

Parents

Your Contact Information

Social Media (Optional)

Social Media

Employment Information

Employment Details