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Mandatory fields are marked with an asterisk (*). A Surname and Given Name are required for registration purposes. Applicants with only one name should enter it into the Surname field, and a hyphen (-) into the Given Name field. If you have any special characters in your name, please use equivalent English characters.

* Applicant's Salutation:

- Select - Mr. Miss Mrs.

* Last/Sur/Family Name:

Middle/Additional Name:

* First/Given Name:
Input hyphen (-) if you have only one name

* Have you entered your name exactly as it appears in your passport?

Yes No

* Date of Birth: (Format: 01-JAN-1990)

Date of Birth: (Format: 01-JAN-1990)

* Nationality:

Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Boliva Bosnia & Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congos Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Czechoslovakia Dem. Rep. of the Congo Denmark Dijibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia German Democratic Rep. Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island & McDonald Island Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Dem. Rep Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Lybia Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Ireland Northern Mariana Islands Norway Not Applicable Oman Pakistan Palau Palestinian Territory Occupied Panama Papua New Guinea Paraguay Peru Philipines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Samoa San Marino San Tome & Principe Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & Sandwich Is. South Korea Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre & Miquelon St. Vincent & the Grenadines Sudan Suriname Svalbard & Jan Mayen Islands Swaziland Sweden Switzerland Syrian Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu U.S. Minor Outlying Islands U.S. Virgin Islands Uganda Ukraine Union of Soviet Socialist Rep. United Arab Emirates United Kingdom United States of America Unknown Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Wales Wallis & Futuna Islands Western Sahara Yemen Yemen, Democratic Yugoslavia Zambia Zimbabwe

* Mailing Address:

Mailing Address 2:

* City:

Province/State:

* Country:

Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Boliva Bosnia & Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congos Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Czechoslovakia Dem. Rep. of the Congo Denmark Dijibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia German Democratic Rep. Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island & McDonald Island Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Dem. Rep Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Lybia Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Ireland Northern Mariana Islands Norway Not Applicable Oman Pakistan Palau Palestinian Territory Occupied Panama Papua New Guinea Paraguay Peru Philipines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Samoa San Marino San Tome & Principe Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & Sandwich Is. South Korea Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre & Miquelon St. Vincent & the Grenadines Sudan Suriname Svalbard & Jan Mayen Islands Swaziland Sweden Switzerland Syrian Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu U.S. Minor Outlying Islands U.S. Virgin Islands Uganda Ukraine Union of Soviet Socialist Rep. United Arab Emirates United Kingdom United States of America Unknown Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Wales Wallis & Futuna Islands Western Sahara Yemen Yemen, Democratic Yugoslavia Zambia Zimbabwe

Postal Code:

Telephone # with Area Code:

* Applicant Email:

* Applicant Passport Number:

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* Security Question 1:

- Select - What is the name of the first beach you visited? In what city or town did you meet your spouse/partner? What was the make and model of your first car? What was your maternal grandfather’s first name? In what city or town does your nearest sibling live? What was the name of your first stuffed animal or doll or action figure? What were the last four digits of your childhood telephone number? What was your favorite place to visit as a child? What was your high school mascot?

* Answer 1:

* Security Question 2:

- Select - What was your favorite place to visit as a child? What is the country of your ultimate dream vacation? What is the name of your favorite childhood teacher? In what city were you born? What high school did you attend? What is the name of your favorite pet? What is the name of your first grade teacher? When is your anniversary? Which is your favorite web browser?

* Answer 2:

* Security Question 3:

- Select - What is the name of your first school? What is your father's middle name? What is your favorite color? What is your favorite movie? What is your mother's maiden name? What street did you grow up on? What was the make of your first car? Who is your favorite actor, musician, or artist?

* Answer 3:

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