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Please select the visa application type

Visa route*

United States of America IMMIGRATION

Please complete the form below.

Please also note that it is very important to enter accurate data, which will be needed in completing your free assessment.

Enter all surnames as listed in your passport. If only one name is listed in your passport, enter that Surname.
If your passport does not include a given name, please enter 'FNU' in Given Names.
Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)?
Do you have a telecode that represents your name?
Sex*
Spouse's Date of Birth
Date of Birth*
(Format: DD-MMM-YYYY)

United States of America IMMIGRATION

ENTER APPLICANT INFORMATION


Please also note that it is very important to enter accurate data, which will be needed in completing your free assessment.

Refer to your passport and enter all information in the same format.
Refer to your passport and enter all information in the same format.
Gender*
Are you known by any other names or aliases?*
Date of Birth*
(Format: DD-MMM-YYYY)
Issuance Date*
Expiration Date*
Have you ever been issued a passport or national identity card for travel by any other country?*
Expiration date*
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?*

PARENTS details

YOUR CONTACT INFORMATION

Address*

EMPLOYMENT INFORMATION

Do you have a current or previous employer?*
Address*

US Contact details

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

U.S. POINT OF CONTACT INFORMATION

Address*

ADDRESS WHILE IN THE U.S.

Address*

EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.

ELIGIBILITY QUESTIONS

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):* 1) Cholera 2) Diphtheria 3) Tuberculosis, infectious 4) Plague 5) Smallpox 6) Yellow Fever 7) Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo 8) Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.*
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?*
Have you ever violated any law related to possessing, using, or distributing illegal drugs?*
Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?*
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?*
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?*
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?*
Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?*
Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia or Yemen on or after March 1, 2011?*

Personal Information 2
Do you hold or have you held any nationality other than the one indicated above on nationality?*
Do you hold a passport for the other country/region of origin (nationality) indicated above?*
Are you a permanent resident of a country/region other than your country/region of origin (nationality) indicated above?
If this does not apply to you please type N/A
If this does not apply to you please type N/A
If this does not apply to you please type N/A

Address and Phone Information

Home Address*
Is your Mailing Address the same as your Home Address?*
Provide your mailing address:*

Passport Information

Issuance Date*
(Format: DD-MMM-YYYY)
Expiration Date*
(Format: DD-MMM-YYYY)
Have you ever lost a passport or had one stolen?

Provide the following information:

Travel Information

NOTE: Provide the following information concerning your travel plans.

Intended Date of Arrival
(Format: DD-MMM-YYYY)
Address Where You Will Stay in the U.S.
Is the address of the party paying for your trip the same as your Home or Mailing Address?

Travel Companions Information

NOTE: Provide the following travel companion information.

Are there other persons traveling with you?*
Are you traveling as part of a group or organization?*

Previous U.S. Travel Information

NOTE: Provide the following previous U.S. travel information. Provide complete and accurate information to all questions that require an explanation.

Have you ever been in the U.S.?

Provide information on your last five U.S. visits

Date Arrived
Do you or did you ever hold a U.S. Driver’s License?
Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?
Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services?

U.S. Point of Contact Information

Contact Person or Organization in the United States

Address

Family Information: Relatives

NOTE: Please provide the following information concerning your biological parents. If you are adopted, please provide the following information on your adoptive parents.

Father's Full Name and Date of Birth

Date of Birth
(Format: DD-MMM-YYYY)
Is your father in the U.S.?

Mother's Full Name and Date of Birth

Date of Birth
(Format: DD-MMM-YYYY)
Is your mother in the U.S.?
Do you have any immediate relatives, not including parents, in the United States?

Present Work/Education/Training Information

NOTE: Provide the following information concerning your current employment or education.

Present employer or school address:

Security and Background: Part 1

NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.

Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as determined by the Department of Health and Human Services.)
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?
Are you or have you ever been a drug abuser or addict?
Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action?
Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?
Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years?
Have you ever been involved in, or do you seek to engage in, money laundering?
Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?
Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed, or conspired to commit a severe human trafficking offense in the United States or outside the United States?
Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?

Security and Background: Part 2

NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?
Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?
Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?
Are you a member or representative of a terrorist organization?
Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?
Have you ever engaged in the recruitment or the use of child soldiers?
Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?
Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free will?
Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?

Security and Background: Part 3

NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or willful misrepresentation or other unlawful means?
Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court?
Have you voted in the United States in violation of any law or regulation?
Have you ever renounced United States citizenship for the purposes of avoiding taxation?
Terms & Conditions*
This form collects your personal data so as we can conduct work on your behalf and also to add you to our newsletter list for some awesome products, services and projects. Check out our privacy policy for the full story on how we protect and manage your submitted Data!
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