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Travel Documentation Forms
For assistance with an application for a US ESTA please complete the form below:
ESTA APPLICATION FORM
ABOUT YOU
Consent for storing submitted data
Yes, I give permission to store and process my data
No, I don't consent to storing and processing my data
FULL NAME AS SHOWN ON PASSPORT
OTHER CITIZEN OR NATIONAL OF ANY OTHER COUNTRY
ARE YOU KNOWN BY ANY OTHER NAMES OR ALIASES?
HAVE YOU EVER BEEN ISSUED A PASSPORT OR NATIONAL IDENTITY CARD FOR TRAVEL BY ANY OTHER COUNTRY?
ARE YOU A MEMBER OF THE CBP GLOBAL ENTRY PROGRAM?
YES
NO
YOUR CONTACT DETAILS
HOUSE NAME/NUMBER
STREET NAME
COUNTY
POST CODE
COUNTRY
YOUR TELEPHONE NUMBER
YOUR EMAIL ADDRESS
GE MEMBERSHIP
1ST PARENTS SURNAME
1ST PARENTS FIRST NAME
2ND PARENTS SURNME
2ND PARENTS FIRST NAME
EMPLOYMENT
DO YOU HAVE A CURRENT OR PREVIOUS EMPLOYER?
YES
NO
JOB TITLE
COMPANY NAME
COMPANY ADDRESS
COMPANY PHONE NUMBER
ADDRESS IN USA
HOUSE NAME/NUMBER IN USA
STREET NAME IN USA
STATE
COUNTRY (USA)
EMERGENCY CONTACT DETAILS
SURNAME
FIRST NAME
CONTACT TELEPHONE NUMBER
CONTACT EMAIL ADDRESS
ELIGIBILITY QUESTIONS - ANSWER YES/NO
Do you have a physical or mental disorder, drug abuse, or drug addiction or any of the following diseases under section 361 (b) Heath Service Act: Cholera, Diphtheria, Tuberculosis - infectious, Plague, Smallpox, Yellow Fever, Viral Haemorrhagic Fevers including Ebola, Lassa, Marburg, Crimean-Congo or Severe acute respiratory distress that likely cause mortality?
Have you ever been arrested or convicted of a crime that resulted in serious damage to property, or serious harm to a person or government authority?
Have you ever violated any law related to possessing, using or distributing illegal drugs?
Do you seek to engage in, or have you ever engaged in terrorist activities, espionage, sabotage or genocide?
Have you ever committed fraud or misrepresented yourself or others to obtain an entry visa for the USA?
Are you currently seeking employment in the USA or have you currently/previously been employed without permission from the U.S. government?
Have you ever been denied a U.S. visa you applied for with either your current or a previous passport, or have you ever been refused admission to the USA or had an application for admission withdrawn at a U.S. port of entry?
Have you ever stayed in the USA longer than the admission period granted to you by the U.S. government?
Have you travelled to or been present in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1st 2011?
DECLARATION
In order for us to apply for an ESTA on your behalf, please fill in the details below. We are only asking these questions as they are a requirement for applying for an ESTA. We do not keep any of your details on file and will securely destroy this form once we have made the application. Please note that we have no control over the authorisation process and cannot be held responsible if your application is not approved or the information below is incorrect. ESTAs can sometimes take up to 72 hours to approve. We charge a service fee for facilitating the application. Please note that we have been advised that ESTA applications will take a minimum of 2 hours and up to 72 hours to approve. Please speak to your airline for advice on the rules of your ticket and making changes.
I confirm that the information submitted on this form is accurate and that Skybreak accept no liability for any consequences of the information provided being inaccurate and consent to Skybreak processing my data for an ESTA application
I do not consent to Skybreak processing my data for an ESTA application
Customers - Missed A Flight
Missed a Flight - If you have missed your flight or need assistance, our team of experienced travel advisors are here to help.
Airports - Your Service Centre
Skybreak have been based in the north & south terminals at London Gatwick Airport for more than 25 years.
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