Formulario ESTA

The following information is required of every nonimmigrant visitor not in possession of a visitor's visa who is a national of one of the eligible countries. Please enter all information requested. Each member of your traveling party must complete a separate application.

Please provide all responses in English. Mandatory fields are indicated by a red asterisk *

Applicant Information

Applicant Name*

Family Name

First (Given) 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.

In the First (Given) Name field, enter your first (given) name as the first name appears on your passport under the First or Given Name field. Do not include the middle name in this field. The first name is required to complete the application. If you have no first name, then enter the letters FNU which stands for First Name Unknown.

Sex*

Male Female

Choose your gender, either male or female. The gender is required to complete the application.

Birth Date*

In the Day field, choose the day on which you were born. The day of birth is required to complete the application or to check the status of your application.

In the Month field, choose the month in which you were born. The month of birth is required to complete the application or to check the status of your application.

In the Year field, choose the year in which you were born. The year of birth is required to complete the application and to check the status of your application.

City of Birth*

Enter the city, town, village, or hamlet in which you were born. The city, town, village, or hamlet where you were born is required to complete the application. If you do not know the city in which you were born, enter UNKNOWN.

Country of Birth*

Choose the country in which you were born. The country where you were born is required to complete the application.

Passport Information

Passport Number*

Enter your passport number as it appears on your passport. The passport number may contain numbers and/or characters. Please closely distinguish between the number zero and the letter O. The passport number is required to complete the application or to check the status of your application.

Country of Citizenship*

Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.

National Identification Number*

Enter the number on your identity document, other than a passport, issued by your country. The National Identification Number, if issued to you, is required to complete the application. If you do not have a National Identification Number, enter UNKNOWN.

Passport Issuance Date *

In the Day field, choose the day on which your passport was issued, as it appears on your passport under the Date of Issue field. The day on which the passport was issued is required to complete the application.

In the Month field, choose the month in which your passport was issued, as it appears on your passport under the Date of Issue field. The month in which the passport was issued is required to complete the application.

In the Year field, choose the year in which your passport was issued, as it appears on your passport under the Date of Issue field. The year in which the passport was issued is required to complete the application.

Issuing Country*

Choose the country of citizenship, as it appears on your passport. The passport issuing country is required to complete the application.

Personal Identification Number*

Passport Expiration Date*

In the Day field, choose the day on which your passport expires, as it appears on your passport under the Expiration Date or Extension field. The day on which the passport expires is required to complete the application.

In the Month field, choose the month in which your passport expires, as it appears on your passport under the Expiration Date or Extension field. The month in which the passport expires is required to complete the application.

In the Year field, choose the year in which your passport expires, as it appears on your passport under the Expiration Date or Extension field. The year in which the passport expires is required to complete the application.

Other Citizenship/Nationality

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

If Yes, select the country first, then select how you acquired the citizenship/nationality.

Yes No

Country of Citizenship / Nationality

How did you acquire citizenship / nationality from this country?

Other

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

“Previous” means at any time in the past, without limitation.

Yes No

Country of Citizenship / Nationality

E-mail Address*

Confirm E-mail Address

Alternative E-mail Address

Enter the e-mail address at which you can be contacted. The e-mail address is required to complete the application. If you do not have an e-mail address, you may provide an alternative third-party e-mail address belonging to a point of contact (e.g. a family member, friend or business associate.)
Are you known by any other names or aliases? *

Yes No

Indicate whether you are known by any other names or aliases by selecting yes or no. Answering this question is required to complete your application.

Family Name

First (Given) Name

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

If you have never been issued any one of these documents by any other country answer “No” to this question. If you have been issued one of these documents from another country, but you do not remember the passport number or national identification card number and the year of expiration answer “UNKNOWN” in the passport number field and four zeros “0000” in the year of expiration field.

Yes No

Issuing Country

Document Type

Document Number

Expiration Year

Contact Information
Home Address*

Address Line 1

Address Line 2

Apartment Number

City

State/Province/Region

Country

In the Address Line 1 field, enter the number and street. Do not include the city and state in this field. Address line 1 is required to complete the application. The type of road has to be abbreviated as AVE, BLVD, CT, DR, LN, PL, RD, ST, TER, WAY. Example: 1600 Pennsylvania Ave NW.

In the Apartment Number field, enter apartment, suite, unit, or other, as appropriate. Do not include the city and state in this field. Apartment number is optional to complete the application.

In the Address Line 2 field, enter floor, building, or other, as appropriate. Do not include the city and state in this field. Address line 2 is optional to complete the application.

In the City field, enter the city, town, village, or hamlet. The city, town, village, or hamlet is required to complete the application.

In the State/Province/Region field, enter the state, province, or region. The state/province/region is required to complete the application.

In the Country field, choose the country. The country is required to complete the application.

Telephone Number*

Type

Country Code

Telephone Number

At least one telephone number is required to complete the application. If you do not have a telephone number, you may provide an alternative third-party telephone number belonging to a point of contact (e.g. a family member, friend, or business associate).

In the Type field, choose the type of the telephone number where you may be contacted. The telephone type is required to complete the application.

In the Country Code field, enter the country code of the telephone number where you may be contacted. The country code is required to complete the application.

In the Number field, enter the telephone number where you may be contacted. The number is required to complete the application.

GE MEMBERSHIP

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

If you answer Yes to the question, please enter your PASSID/Membership Number.

Yes No

PASSID / Membership Number

Parents
Parents*

Family Name

First (Given) Name

Family Name

First (Given) Name

Enter the names of your parents. These are required to complete the application. 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.

In the Family Name field, enter your parent's family name. The family name is required to complete the application. If you do not know one or both of your parents, enter UNKNOWN.

In the First (Given) Name field, enter your parent's first (given) name. Do not include the middle name in this field. The first name is required to complete the application. If your parent has no first name, or if you do not know one or both of your parents, enter UNKNOWN.

Employment Information

Do you have a current or previous employer?*

Yes No

Indicate whether you have a current or previous employer by selecting yes or no. Answering this question is required to complete your application.

Job Title

Employer Name*

Address Line 1

Address Line 2

City

State/Province/Region

Country

Country Code

Number
Travel Information

Is your travel to the US occurring in transit to another country? *

Yes No

Indicate whether your travel to the U.S. is occurring in transit to another country by selecting yes or no. Answering this question is required to complete your application.

US Point of Contact Information

US Point of Contact*

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.

Address Line 1

In the Address Line 1 field, enter the number and street of your US point of contact's address. Do not include the city and state in this field. Address line 1 is required to complete the application.

Address Line 2

In the Address Line 2 field, enter floor, building, or other, as appropriate. Do not include the city and state in this field. Address line 2 is optional to complete the application.

Apartment Number

In the Apartment Number field, enter apartment, suite, unit, or other, as appropriate. Do not include the city and state in this field. Apartment number is optional to complete the application.

City

In the City field, enter the city. The city is required to complete the application.

State

In the State field, choose the state. The state is required to complete the application.

Country Code

Number

Enter your U.S. point of contact's telephone number. The number is required to complete the application. If you do not have a point of contact telephone number you may enter zeros.

Emergency Contact Information In or Out of the United States

Family Name

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.

First (Given) Name

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 First (Given) Name field, enter the emergency contact's first name. You must complete this field to complete the application. If you have no emergency contact (or your contact has only one name), enter UNKNOWN.

E-mail Address*

Enter your emergency contact's email address. Email address is required to complete the application. You may also enter UNKNOWN.

Country Code *

Number

In the Country Code field, enter the country code of your emergency contact's telephone number. The country code is required to complete the application. If you do not have an emergency contact telephone country code you may enter zeros. In the Phone field, enter your emergency contact's telephone number. The telephone number is required to complete the application. If you do not have an emergency contact telephone number you may enter zeros.
Do any of the following apply to you? (Answer Yes or No)

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.*

Yes No

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?*

Yes No

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

Yes No

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

Yes No

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?*

Yes No

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?*

Yes No

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?*

Yes No

If yes: when

where

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

Yes No

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

Yes No

Country

From

To

Primary Reason

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

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.

Application Submittal

Please review all information for accuracy before submitting your application. If something is inaccurate, select the Previous button and edit the application with the correct information.

Applicant Information

Family Name

First (Given) Name

Are you known by any other names or aliases?

Birth Date Day: Month: Year:

City of Birth

Country of Birth

Sex

Parents

	Family Name	First (Given) Name

Passport Information

Passport Number

Issuing Country

Personal Identification Number

Passport Issuance Date Day: Month: Year:

Passport Expiration Date Day: Month: Year:

Country of Citizenship

National Identification Number

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

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

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

Are you a member of the CBP Global Entry Program?

Contact Information

E-mail Address

Telephone Number

	Type	Country Code	Telephone Number

Home Address

	Address Line 1	Apartment Number

	Address Line 2	City

	State/Province/Region	Country

Emergency Contact Information In or Out of the United States

Emergency Contact

	Family Name	First (Given) Name

Telephone Number

	Country Code	Number

E-mail Address

Travel Information

Is your travel to the US occurring in transit to another country?

Employment Information

Do you have a current or previous employer?

Do any of the following apply to you? (Answer Yes or No)

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

Please review all information for accuracy before submitting your application. If something is inaccurate, select the Previous button and edit the application with the correct information.

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.

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ESTA Application

Applicant Information

Passport Information

Other Citizenship/Nationality

Contact Information

GE MEMBERSHIP

Parents

Employment Information

Travel Information

US Point of Contact Information

Emergency Contact Information In or Out of the United States

Do any of the following apply to you? (Answer Yes or No)

Application Submittal

Applicant Information

Passport Information

Contact Information

Emergency Contact Information In or Out of the United States

Travel Information

US Point of Contact Information

Employment Information

Do any of the following apply to you? (Answer Yes or No)

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