General details

Please provide all your details below. Copy them carefully from your passport. You have to apply for a visa on behalf of all travelers (including children listed in their parents' passport). You can do this within the same application by clicking on '+ traveler". You only need to fill out the general details once (all visa documents will be sent to the same address). It is not required for all travelers to be living on the same address, the address is only used to deliver the visas via regular mail if you opt to use this.

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Fill in you planned arrival date
Please provide your email address where you wish to receive your visa. Review it carefully.

Address

Fill in the address of one of the travelers. The travelers do not have to be living at this address together.

Order details

Please fill out the generic order details below. You only need to fill them out once. They apply to all travellers.

Emergency contact

For the application it is necessary to specify an emergency contact person, who is contacted in the event of an emergency. This can be a family member, friend, or business associate for example.

Transit (passing through)

If you are a transit passenger (your final destination is not this country) and do not actually enter this country, select yes below. If you will be entering the country, select no.

If you are a transit passenger (your final destination is not this country) and do not actually enter this country, select yes below. If you will be entering the country, select no.

Traveler 1

Fill out the traveler's general details below. For help, click the "i" icon or the label/field. Please pay special attention to the fields "first given name" and "family name".

You have to enter your first name exactly as stated in the passport. If your passport contains more first names, then write all of them down.
You must fill in your surname exactly as stated in the passport. Women only enter their maiden name, not the married name.
Fill in the place of birth, as stated in your passport/ID card. If you don't know the place you where born, enter UNKNOWN.
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Fill in the date of birth as stated in you passport

Aliases

Please indicate if you are known by any official aliases by selecting yes or no below. If you are known by an official alias, please fill out both the first and last name of your official alias. If you have an official alternative last name, but no alternative first name, please fill out FNU in the first name input box. If you have more than two official aliases, please contact us.

Please indicate if you are known by any official aliases by selecting yes or no below. If you are known by an official alias, please fill out both the first and last name of your official alias. If you have an official alternative last name, but no alternative first name, please fill out FNU in the first name input box. If you have more than two official aliases, please contact us.

Parents name

Enter the full names of your parents (first and last names). The names of your parents are mandatory for the processing of the application. You must also fill in the nationality, place of birth and the country of birth. You can enter the names of your biological, adoptive, step or foster parents in this field. If you are married, the details of your partner are also obliged.

Passport details

Please enter your passport details exactly as they appear on the passport.

Select the country that issued your passport, as stated on the passport.
Fill the document number, as stated in your document. You can find the document number on the right top side. For Dutch passports the passport number is nine characters long and starts with the letter (N,B,A,D). The Dutch passport number contains both numbers and letters. For Belgium passports the passport number is eight characters long. It has the following form: XX999999 (two letters, six digits).
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Please select the issued date of your passport, as stated in the passport.
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Please select the expiration date of your passport, as stated in your passport.
If you want, you can upload this document later. You can then just leave this field empty right now.

Alternative passports

Have you been a citizen or resident of any country (other than your passport country) in the past? Then select Yes below and fill in the required fields. If you do not know what to enter here, enter NO.

Have you been a citizen or resident of any country (other than your passport country) in the past? Then select Yes below and fill in the required fields. If you do not know what to enter here, enter NO.

Alternative citizenship (current)

Are you currently a citizen or resident of any country (other than your passport country)? Then select YES below and fill in the required fields. If you do not know what to enter here, enter NO.

Are you currently a citizen or resident of any country (other than your passport country)? Then select YES below and fill in the required fields. If you do not know what to enter here, enter NO.

Alternative citizenship (past)

Employer

Please select yes if you have a current or previous employer. Select no if you have never worked. If you have a current or previous employer, if you are a freelancer or a student "select yes" and fill out the fields below.

Please select yes if you have a current or previous employer. Select no if you have never worked. If you have a current or previous employer, if you are a freelancer or a student "select yes" and fill out the fields below.

Social media profiles

Enter information related to your online presence over the past five years here.

Questions

Below are eight questions related to your health or past. If you answer "Yes" to any of these questions, unfortunately we cannot process your ESTA application. A brief explanation for each question:

  • Health problem: Do you have a physical or mental disorder; or are you a drug user or addict; or if you currently have one of the following diseases (Chancroid, Gonorrhea, Granuloma inguinale, Leprosy, contagious, Lymphogranuloma venereum, Syphilis, contagious, Active tuberculosis), enter "yes" for this question.
  • Arrested: If you have ever been arrested or convicted of a crime resulting in serious damage to property, or serious harm to another person or government, enter "yes" for this question.
  • Drugs: If you have ever broken a law regarding the possession, use, or distribution of illegal drugs, enter "yes" at this question.
  • Terrorism: If you intend or have you ever been involved in terrorist activities, espionage, sabotage or genocide, please enter "yes" for this question.
  • Fraud: If you have ever committed fraud or misrepresented yourself or others to obtain a visa or entry into the United States for yourself or others, please enter "yes" at this question.
  • Job Seeker: If you are currently seeking work in the United States, or have previously worked in the United States without prior approval from the United States government, please enter "yes" at this question.
  • Visa Rejection: Visa Rejected: Have you ever been denied a US visa that you applied for with your current or previous passport, or have you ever been denied entry to the United States or revoked your entry application at an entry point to the US, please fill out please enter "yes" at this question.
  • Time limit exceeded: If you have ever stayed in the United States longer than the period of stay permitted by the United States government, please enter "yes" in this question.
  • Cuba, Iraq, Syria, Iran, Sudan, Libya, Somalia, North Korea or Yemen: Have you been to Cuba, Iraq, Syria, Iran, Sudan, Libya, Somalia, North Korea or Yemen, or have you visited these countries on or after 1 March 2011, fill in "yes" for this question

Do you have one of these conditions? Untreated syphilis, untreated drug or alcohol addiction or untreated mental health condition with psychosis