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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:

Disclaimer

Yes, I have read and understand the information and agree to these terms.

No, I need additional clarification or I decline to provide acknowledgment.

Please note that after payment, a passport photo will be requested via email. Please reply urgently to complete the application.

Last name (as in passport)

First name

Sex

Date of Birth

City of Birth

Country of Birth

Passport Number

Country of Citizenship

National Identification Number

Issuing Country

Personal Identification Number

Issuance Date

Expiration Date

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

Issuing Country

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

Country of Citizenship / Nationality

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

Country of Citizenship / Nationality

Are you a member of the CBP Global Entry Program?

Please list your parents names in the boxes. All applicants are required to fill out this section. If you do not know the name of one or both of your parents, enter UNKNOWN, for each parent. This field can include the names of your biological, adoptive, step-parent or guardian.

Family Name

First (Given) Name

Family Name

First (Given) Name

Please enter your contact information below.

Address

City

Zip

State/Province/Region

Country

Telephone Type

Country Code

phone

E-mail Address

Confirm E-mail Address

Other E-mail Address

Please enter information associated with your online presence. List the username, handle, screen-name, or other identifier associated with your social media profile.
If you don't have social networks, select the I'm not online item from the menu.

Provider / Platform

Social Media Identifier

Do you have a current or previous employer? (answering yes, all information on the employer is mandatory, including address and telephone)

Country

It is in transit to another country? (So it will not stop in the US)

A U.S. point of contact may be a friend, relative, or business associate. If you do not have a U.S. point of contact, please enter the name, address and telephone number of the location where you will be staying (e.g. a hotel name). You may also enter UNKNOWN.

The address where you will be staying in the U.S. is optional to complete the application. If multiple locations are planned, enter the first address. If the complete address is not known, enter the name of the hotel or location you will visit.

Enter your emergency point of contact who may be a person in or outside of the United States, e.g., a family member, friend, or business associate. In the Family Name field, enter your emergency contact's family name. You must complete this field to complete the application. If you have no emergency contact, enter UNKNOWN.

Family Name

First (Given) Name

E-mail Address

Country Code

phone

1) 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.

2) 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?

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

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

5) 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?

6) 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?

7) 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?

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

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

Country 1

From

Primary Reason

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

I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.

THIRD PARTIES ONLY

For third-parties submitting the application on behalf of the applicant, I hereby certify that I have read to the individual whose name appears on this application (applicant) all the questions and statements on this application. I further certify that the applicant certifies that he or she has read, or has had read to him or her, all the questions and statements on this application, understands all the questions and statements on this application, and waives any rights to review or appeal of a U.S. Customs and Border Protection Officer's determination as to his or her 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. The answers and information furnished in this application are true and correct to the best of the applicant's knowledge and belief.

Disclaimer

About the Traveler

Other Citizenship/Nationality

GE MEMBERSHIP

PARENTS

YOUR CONTACT INFORMATION

SOCIAL MEDIA

EMPLOYMENT INFORMATION

TRAVEL INFORMATION

Points of Contact in the US

Address during your stay in the U.S

INFORMATION ON AN EMERGENCY CONTACT INSIDE OR OUTSIDE USA

ELIGIBILITY QUESTIONS

WAIVER OF RIGHTS