US Visa Application Form

Please select the visa application type

VISA ROUTE*

ESTA (Electronic System for Travel Authorisation)

Other

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.

Surnames*

Enter all surnames as listed in your passport. If only one name is listed in your passport, enter that Surname.

Given Names*

If your passport does not include a given name, please enter ‘FNU' in Given Names.

Full Name in Native Alphabet

HAVE YOU EVER USED OTHER NAMES (I.E., MAIDEN, RELIGIOUS, PROFESSIONAL, ALIAS, ETC.)?

Yes

No

Other Surnames Used (maiden, religious, professional, aliases, etc.) and Other Given Names Used

DO YOU HAVE A TELECODE THAT REPRESENTS YOUR NAME?

Yes

No

Other Surnames Used (maiden, religious, professional, aliases, etc.) and Other Given Names Used*

SEX*

Male

Female

Marital Status*

DATE OF BIRTH

Place of Birth*

Country of Birth*

US Contact details

IS YOUR TRAVEL TO THE US OCCURRING IN TRANSIT TO ANOTHER COUNTRY?

Yes

No

U.S. POINT OF CONTACT INFORMATION

Name

Address*

Street Address Address Line 2 City State Zip/ Postal Code

Telephone / Mobile Number

ADDRESS WHILE IN THE U.S.

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

Family Name*

First (Given) Name*

Emergency Contact Email Address*

Contact Number*

Personal Information 2

Country/Region of Origin (Nationality)*

DO YOU HOLD OR HAVE YOU HELD ANY NATIONALITY OTHER THAN THE ONE INDICATED ABOVE ON NATIONALITY?*

Yes

No

Country/Region of Origin (Nationality)

ARE YOU A PERMANENT RESIDENT OF A COUNTRY/REGION OTHER THAN YOUR COUNTRY/REGION OF ORIGIN (NATIONALITY) INDICATED ABOVE?

Yes

No

Other Permanent Resident Country/Region

National Identification Number

If this does not apply to you please type N/A

U.S. Social Security Number

If this does not apply to you please type N/A

U.S. Taxpayer ID Number

If this does not apply to you please type N/A

Address and Phone Information

Home Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

IS YOUR MAILING ADDRESS THE SAME AS YOUR HOME ADDRESS?*

Yes

No

Provide your mailing address:*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Gender*

Primary Phone Number*

Secondary Phone Number

Work Phone Number

Your Email Address*

Passport Information

Passport/Travel Document Type*

Passport/Travel Document Number*

Passport Book Number

Country/Authority that Issued Passport/Travel Document*

Where was the Passport/Travel Document Issued?*

ISSUANCE DATE*

EXPIRATION DATE*

HAVE YOU EVER LOST A PASSPORT OR HAD ONE STOLEN?

Yes

No

Provide the following information:

Passport/Travel Document Number

Country/Authority that Issued Passport/Travel Document*

Explain

Travel Information

NOTE: Provide the following information concerning your travel plans.

Purpose of Trip to the U.S.*

Please specify

INTENDED DATE OF ARRIVAL

Intended Length of Stay in U.S.

Address Where You Will Stay in the U.S.

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Person/Entity Paying for Your Trip

Telephone Number*

Person/Entity Email Address

Relationship to You

IS THE ADDRESS OF THE PARTY PAYING FOR YOUR TRIP THE SAME AS YOUR HOME OR MAILING ADDRESS?

Yes

No

Travel Companions Information

NOTE: Provide the following travel companion information.

ARE THERE OTHER PERSONS TRAVELING WITH YOU?*

Yes

No

ARE YOU TRAVELING AS PART OF A GROUP OR ORGANIZATION?*

Yes

No

Group Name*

Name of Person Traveling With You*

Relationship to You*

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.?

Yes

No

Provide information on your last five U.S. visits

DATE ARRIVED

DO YOU OR DID YOU EVER HOLD A U.S. DRIVER’S LICENSE?

Yes

No

Driver's License Number

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?

Yes

No

Explain

HAS ANYONE EVER FILED AN IMMIGRANT PETITION ON YOUR BEHALF WITH THE UNITED STATES CITIZENSHIP AND IMMIGRATION SERVICES?

Yes

No

Explain

U.S. Point of Contact Information

Contact Person or Organization in the United States

Full name

Relationship to You*

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

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

Surnames

Given Names

DATE OF BIRTH

IS YOUR FATHER IN THE U.S.?

Yes

No

Father's Status

Mother's Full Name and Date of Birth

Surnames

Given Names

DATE OF BIRTH

IS YOUR MOTHER IN THE U.S.?

Yes

No

Father's Status

DO YOU HAVE ANY IMMEDIATE RELATIVES, NOT INCLUDING PARENTS, IN THE UNITED STATES?

Yes

No

Full name

Relationship to You*

Present Work/Education/Training Information

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

Primary Occupation

Present Employer or School Name

Present employer or school address:

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Monthly Income in Local Currency (if employed)

Briefly describe your duties:

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?

Yes

No

Explain*

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?

Yes

No

Explain*

HAVE YOU VOTED IN THE UNITED STATES IN VIOLATION OF ANY LAW OR REGULATION?

Yes

No

Explain*

HAVE YOU EVER RENOUNCED UNITED STATES CITIZENSHIP FOR THE PURPOSES OF AVOIDING TAXATION?

Yes

No

Explain*

TERMS & CONDITIONS*

I consent to iam (immigration and migration) and it's group companies collecting my data.

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!

Awesome! Let’s Get Started…

US Visa Application

Please select the visa application type

US Contact details

U.S. POINT OF CONTACT INFORMATION

ADDRESS WHILE IN THE U.S.

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

ELIGIBILITY QUESTIONS

Personal Information 2

Address and Phone Information

Passport Information

Travel Information

Travel Companions Information

Previous U.S. Travel Information

Provide information on your last five U.S. visits

U.S. Point of Contact Information

Family Information: Relatives

Present Work/Education/Training Information

Security and Background: Part 1

Security and Background: Part 2

Security and Background: Part 3