Visa form - Visa4Travel

1. Document
2. Confirmation
3. Payment

Travel details

Destination

Nationality

Purpose

General Data

Enter all your details below. Take this carefully from your passport. You must apply for a visa for all travelers. You can do this in one go by clicking on "add traveler" at the bottom. You only need to enter the general details once (all visas will be sent to the same address). It is not necessary that all travelers are resident at the address entered. The address is only used for sending the visas, if desired.

Arrival Date

Email Address

Phone Number

Address

Enter the address of one of the travelers. The travelers do not all have to live at this address.

Country

Street Name

House number

City

Postcode

Province

Emergency Contact

For the application it is necessary to provide an emergency contact person, who will be contacted in case of emergency. This can be a family member, friend, or business associate.

First Name

Last Name

Phone Number

E-mail Address

Transit

If you are passing through and do not actually enter the country, select Yes here. If you actually enter the country, select No.

Transit

Contact point United States

A point of contact in the United States may be a friend, family member, or business associate. If you do not have a point of contact in the United States, enter the name, address, and phone number of the location where you are staying (for example, a hotel name). You can also enter UNKNOWN.

Name

Street Name

City

State

Phone Number

Waiver of Rights

U.S. Customs requires that you waive your rights to review or appeal to a U.S. Customs and Border Guard officer decision regarding your right of admission.

Waiver Of Rights

Traveler 1

Enter the general details of the traveler below. Click for explanation on the label / field or the i-tje. Pay particular attention to the "All first names" and "last name" fields.

Gender

Nationality

First Name

Surname

Nationality At Birth

Birth Place

Date of Birth

Official Alias

Indicate whether you are known by other names or aliases by selecting yes or no. Only official names must be entered. If you are known by an alternative name, enter both the alternative first and last name. If you do not have an alternate first name, but do have an alternate last name, enter FNU for the first name, which means unknown first name. You can enter up to two alternative first and last names. Do you have more than two official names? Please contact us.

Official Alias

First Name

Last Name

Name of Parents

Enter the names of your parents. These are mandatory for processing the application. If you don't know the name of a parent, enter UNKNOWN for this parent. You can enter the names of your biological, adoptive, step or foster parents in this field.

Father's First Name

Father's Surname

Mother's First Name

Mother's Surname

Passport Information

Please enter the information of your passport below. For Dutch people, the document number is nine characters long and starts with a letter (N, B, A, D). The Dutch passport number contains both numbers and letters. For Belgians, the passport number is eight characters long. It has the form: XX999999 (two letters, six numbers).

Delivery Country

Document Number

Citizen Service Number

Issue Date

Expiration Date

Passport Scan

The maximum file size shouldn't be bigger more than 500KB. If desired, you can also upload this file later. You can now leave this field empty.

Alternative Passport

If you have had an alternative passport now or in the past (of a nationality other than your current one), please enter the details of this or these passports below. Please note: you do not have to fill in your previous passports with the same nationality.

Alternative Passport

Country of Delivery

Document Number

Expiry Year

Alternative citizenship (current)

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

Alternative Citizenship (current)

Current Citizen Country

Obtained By

Alternative citizenship (past)

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

ALTERNATIVE CITIZENSHIP (PAST)

Past Citizen Country

Employer

Select here whether you have a former or current employer. You select yes if you have an employer, self-employed person, student, child, house husband / wife, stay-at-home parent, etc. Any description of your work situation is permitted. Read the information in the fields below for exactly what you need to fill in. Fill in the fields in English.

Employer

Name of Employer

Street Name + House Number

City

Province

Country

Telephone Number

Urgent Request

Delivery time

Embassy Registration - Recommended

Travel safely
Have TRAVELDOCS register your trip with the Ministry of Foreign Affairs so that you can travel with confidence. The Dutch Ministry of Foreign Affairs advises Dutch travelers to register at the embassy in the countries they will visit. Registration means that the Dutch embassy in the country of destination will be aware of your travel plans and that you are registered in the crisis registration system so that you are always aware of important events.

Yes, € 19.95 per person

Questions

Below are eight questions related to your health or past. If you answer "Yes" to one of these questions, we are unfortunately unable to process your ESTA application. A brief explanation of 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 any of the following diseases (Chancroid, Gonorrhea, Granuloma inguinale, Leprosy, contagious, Lymphogranuloma venereum, Syphilis, contagious, Active tuberculosis), enter "yes" in this question.
Arrested: If you have ever been arrested or convicted of a crime resulting in serious property damage, or serious harm to another person or government, please enter "yes" to this question.
Drugs: If you have ever broken a law regarding the possession, use, or distribution of illegal drugs, enter "yes" to this question.
Terrorism: If you intend or have ever been involved in terrorist activities, espionage, sabotage, or genocide, please enter "yes" to 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 answer "yes" to this question.
Job seeker: Are you currently looking for a job in the United States, or have you previously worked in the United States without prior permission from the United States government, please enter "yes" in this question.
Visa Rejection: Visa Rejected: Have you ever been denied a US visa that you applied for with your current or a previous passport, or have you ever been refused entry to the United States or have you revoked your application for entry at an access point to the US? please enter "yes" to this question.
Deadline exceeded: If you have ever stayed in the United States longer than the period of stay allowed by the United States government, enter "yes" to this question.
Iraq, Syria, Iran, Sudan, Libya, Somalia, North Korea or Yemen: Have you visited Iraq, Syria, Iran, Sudan, Libya, Somalia, North Korea or Yemen on or after 1 March 2011, enter "yes" for this question .

Health Problem

Arrested

Drugs

Terrorism

Fraud

Job Seeker

Visa rejection

Deadline Exceeded

IRAQ, SYRIA, IRAN, SUDAN, LIBYA, SOMALIA, NORTH KOREA OR YEMEN

Add a traveler

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Visa USA

Do you need help filling in a certain field?
For some fields there is alreay an explanation given. If you need further assistance, please contact us.

+31 (0) 23 - 221 00 04

1. Document

2. Confirmation

3. Payment

Visa USA

Travel details

Are you sure to change to business purpose? Are you sure to change to tourism purpose? Are you sure to change to E-Visa purpose?

General Data

Address

Emergency Contact

Transit

Contact point United States

Waiver of Rights

Traveler 1 Remove Traveler 1

Official Alias

Name of Parents

Passport Information

Alternative Passport

Alternative citizenship (current)

Alternative citizenship (past)

Employer

Urgent Request

Embassy Registration - Recommended

Questions

Visa USA

Traveler 1