USA ESTA APPLICATION FORM

Transcription

1 THANK YOU FOR CHOOSING VISA FIRST TO PROCESS YOUR VISA APPLICATION. THIS IS YOUR VISA FIRST APPLICATION PACK WHICH CONTAINS: INFORMATION ON THE DOCUMENTS YOU WILL NEED TO PROVIDE IN ORDER TO OBTAIN A VISA ORDER FORM VISA APPLICATION FORM Please make sure to read all information provided carefully. Once you have gathered all required documents please print off, fill out and sign the application form provided. Please then send the completed form and the required documents to our address. If you have any further questions please do not hesitate to contact us. You can contact us by: info@visafirst.com +44(0) from the UK +353(0) from Ireland

2 INFORMATION OF APPLICANT: Family name: Are you known by any other names or aliases? Yes No If yes, please provide details: Date of birth: DAY / MONTH / YEAR City of birth: Country of birth: Gender: Male Female address: Phone number: Home address: FAMILY INFORMATION: Father s family name: Mother s family name: PASSPORT INFORMATION: Passport number: Passport issuing country (country of citizenship): Passport Issuance Date: DAY / MONTH / YEAR Passport Expiration Date: DAY / MONTH / YEAR Are you a citizen or national of any other country? Yes No If yes, please provide details: Have you ever been a citizen or national of any other country? Emergency contact information of a person inside or outside the United States Enter your emergency point of contact who may be a person inside 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. 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. Family name: Phone number of contact: Given names: address of contact:

3 TRAVEL INFORMATION: Is your travel to the US occurring in transit to another country? Yes No POINT OF CONTACT INFORMATION IN THE UNITED STATES: 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. Home Address: Phone Number: ADDRESS WHILE STAYING IN THE UNITED STATES? Home address, address of hotel, hostel etc. EMPLOYMENT INFORMATION: Are you currently employed? Yes No If yes, please provide details of current employer. If unemployed please provide details of previous employer. Employer name: Address: Phone number: Job title: QUESTIONNAIRE: Do any of the following questions apply to you? Please answer all questions with either yes or no. Do you have a physical of mental disorder, are you a drug abuser or addict or do you currently have any of the following diseases: Chancroid Gonorrhea Active Tuberculosis Lymphogranuloma venereum Granuloma Inguinale Leprosy Syphilis 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 Have you ever violated any law related to possessing, using, or distributing illegal drugs? Yes No Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide? Yes No 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 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 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 Date visa was denied: DAY / MONTH / YEAR Place visa was denied: DAY / MONTH / YEAR Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government? Yes No Have you traveled to, or been present in Iraq, Syria, Iran, or Sudan on or after March 1, 2011? Yes No

4 VISA OPTIONS: US ESTA: AU$75 PAYMENT DETAILS: Method of payment: Online payment: a link will be sent to your so you can securely pay online. Bank draft or postal order NB: Please make postal order and bank draft payments payable to Taxback - Visa First Division. For all payments made by a credit or debit card there is a 3% transaction fee

5 TERMS AND CONDITIONS Visa First reserves the right to return any passport without the requested visa if the passport and/ or the documents provided do not comply with the requirements or if there is insufficient time to process the visa. Please note that, other documents may be requested at the discretion of the embassy. The provided processing time is given as a general guidelines - actual waiting times may vary. The visa fee is non-refundable even in the event that your application is delayed or rejected. Passports are required for the entire processing time. In the event of loss or damage to any passport or documents received, Visa First liability will be limited to the actual value of the passport/document. Visa First accepts no liability for consequential loss. You must travel with the same passport you hold at time of completing this application. If you obtain a new passport after your visa has been issued, please contact Visa First Help Desk for advice. In this case Reallocation fees may apply. Visa First advises against purchasing restricted or inflexible tickets prior to visa issuance. Processing times shown on this application are standard processing times. While Visa First makes every effort to ensure that visas are processed according to advertised timelines, Visa First does not accept any claims for delays caused by postal strikes or delayed post handling by postal companies or embassies which are outside of our control. Please confirm that by engaging the services of Visa First, you agree to our terms and conditions listed above, which you can view at Signature of applicant: