ESTA UK Electronic System for Travel Authorization

ESTA Application Form

Refer to your passport while you fill the following form fields below. Each application must contain biographical, travel, contact and employment information. The applicant must also answer VWP eligibility questions regarding communicable diseases, arrests and prosecution of certain offenses, history of visa revocation or deportation and other related questions.

Each traveler is responsible for the accuracy of their own application. The traveler or applicant also needs a valid credit card in order to pay for the fees associated with the request to complete the ESTA application.

Fields marked with an * are required

Applicant Information

Applicant Name

 

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Birth Date

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Parents

 

Passport Information

The passport number may contain numbers and/or characters. Please closely distinguish between the two, such as the numbers zero and one, and the letters O and I.

(Country of Citizenship)

Passport Issuance Date

 

 

Passport Expiration Date

 

 

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Contact Information

Telephone Number

 

 

Home Address

 

 

Emergency Contact Information In or Out of the United States

Emergency Contact

 

Telephone Number

 

Travel Information

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Employment Information

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

  • Chancroid
  • Gonorrhea
  • Granuloma Inguinale
  • Leprosy, infectious
  • Lymphogranuloma venereum
  • Syphilis, infectious
  • Active Tuberculosis

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.

Billing Information

Credit Card Information

$74 USD All Inclusive CBP's and data processing fees.