Consult your passport and enter all the data in the same format.
Expiry date *
Are you now a citizen or national of any other country ? * YesNo
Have you been a citizen or national of another country? * YesNo
IMPORTANT: Your application number will be sent to the email address listed below. You must verify your email address to complete your request.
Adresse e-mail
Confirm email address
Please give all answers in English.
Are you known by any other names or aliases ? YesNo
Have you ever had a passport or national identity card issued to you by another country to travel? YesNo
Please provide your contact details below.
Are you a member of the CBP Global Entry program ? YesNo
Please fill in the names of your parents in the boxes to the right. All applicants must complete this section.
Do you have a current or former employer?
YesNo
Is your trip to the United States a transit to another country ? YesNo
Name *
The address where you will be staying in the United States is optional for completing the application. If multiple locations are planned, type the first address. If the full address is not known, type the name of the hotel or place you are going to visit.
Is your Address While in the United States the same as the US Point of Contact Address listed above? YesNo
Do you suffer from a physical or mental illness, are you a drug addict or chronic drug addict or do you suffer from any of the following illnesses : YesNo
Have you been arrested or convicted of an offense that caused serious property damage or serious harm to another person or government authority ? YesNo
Have you ever violated any law in connection with the possession, use or trafficking of illegal drugs ? YesNo
Do you intend to participate or have you participated in terrorist activities, espionage, sabotage or genocide ? YesNo
Have you ever committed fraud or misrepresented yourself or others to obtain or assist others in obtaining a U.S. visa or entry ? YesNo
Are you currently seeking employment in the United States or have you worked in the United States in the past without obtaining prior permission from the U.S. government ? YesNo