Official ESTA Application Website, U.S. Customs and Border Protection

Official Website of the Department of Homeland Security
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AUTHORIZATION APPROVED
Your travel authorization has been approved and you are authorized to travel to the United States under the
Visa Waiver Program. This does not guarantee admission to the United States; a Customs and Border
Protection (CBP) officer at a port of entry will have the final determination.
APPLICATION NUMBER EXPIRATION DATE
02O2442I2221218S 03/29/2025
PAYMENT RECEIPT
Payment Date: March 29, 2023 12:50:0 PM
Payment Tracking Code: 274N4DC9
Payment Received: $21.00
APPLICANT INFORMATION
Family Name First (Given) Name Passport Number

HAFIZ MOHAMMED ABDUL 555545504
Issuing Country Issuance Date Expiration Date

UK - BRITISH CITIZEN (GBR) June 20, 2018 January 20, 2029
Country of Citizenship / National Identification Number Personal Identification Number

Nationality
UK - BRITISH CITIZEN (GBR)
Sex Date of Birth City of Birth

Male November 19, 1991 BIRMINGHAM
Country of Birth
UNITED KINGDOM (GBR)
OTHER CITIZENSHIP/NATIONALITY
Are you now, a citizen or national of any other country? No
Have you ever been a citizen or national of any other country? No
E-mail Address Confirm E-mail Address

MOHAMMED- MOHAMMED-
HAFIZ@HOTMAIL.CO.UK HAFIZ@HOTMAIL.CO.UK
PERSONAL INFORMATION
Are you known by any other names or aliases? No
Have you ever been issued a passport or national identity card for travel by any other country? No
YOUR CONTACT INFORMATION
Address Line 1 Address Line 2 Apartment Number

3 AVONDALE ROAD
City State/Province/Region Country

BIRMINGHAM WEST MIDLANDS UNITED KINGDOM (GBR)
Telephone Type Country Code Phone Number

Mobile UNITED KINGDOM (GBR) (+44) 7968947433
SOCIAL MEDIA (OPTIONAL)

N/A
GE/NEXUS/SENTRI MEMBERSHIP
Are you a member of the CBP Global Entry/NEXUS/SENTRI Program? No
PARENTS
Family Name First (Given) Name

JALIL MOHAMMED ABDUL
Family Name First (Given) Name

NAHER JALIL AZIZUN
EMPLOYMENT INFORMATION
Do you have a current or previous employer? Yes
Job Title Employer Name

LAND CONSULTANT MOTT MACDONALD
Address Line 1 Address Line 2

35 NEWHALL ST
City State/Province/Region Country

BIRMINGHAM WEST MIDLANDS UNITED KINGDOM (GBR)
Country Code Phone Number

UNITED KINGDOM (GBR) (+44) 1212341500
TRAVEL INFORMATION
Is your travel to the US occurring

in transit to another country? No
U.S. Point of Contact Information

Name
NASIMA KHANOM

425 EAST 105 STREET 11D
City State/Province/Region
NEW YORK NEW YORK

UNITED STATES (USA) (+1) 3479909066
Address While in the U.S.

425 EAST 105 STREET 11D
City State/Province/Region
NEW YORK NEW YORK
EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.
Family Name First (Given) Name E-mail Address

KHANOM NASIMA NASIMAKOBE@GMAIL.COM

UNITED STATES (USA) (+1) 3479909066
ELIGIBILITY QUESTIONS
1) Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently No
have any of the following diseases (communicable diseases are specified pursuant to section
361(b) of the Public Health Service Act):
Cholera
Diphtheria
Tuberculosis, infectious
Plague
Smallpox
Yellow Fever
Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo
Severe acute respiratory illnesses capable of transmission to other persons and likely to
cause mortality.
2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, No
or serious harm to another person or government authority?
3) Have you ever violated any law related to possessing, using, or distributing illegal drugs? No
4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or No
genocide?
5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to No
obtain, a visa or entry into the United States?
6) Are you currently seeking employment in the United States or were you previously employed in No
the United States without prior permission from the U.S. government?
7) Have you ever been denied a U.S. visa you applied for with your current or previous passport, or No
have you ever been refused admission to the United States or withdrawn your application for
admission at a U.S. port of entry?
8) Have you ever stayed in the United States longer than the admission period granted to you by the No
U.S. government?
9) Have you traveled to, or been present in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or No
Yemen on or after March 1, 2011?
Paperwork Reduction Act: An agency may not conduct or sponsor an information collection and a person is not
required to respond to this information unless it displays a current valid OMB control number and an expiration
date. The control number for this collection is 1651-0111. The estimated average time to complete this
application is 23 minutes. If you have any comments regarding this burden estimate you can write to U.S.
Customs and Border Protection, Office of Regulations and Rulings, 90 K Street, NE, 10th Floor, Washington DC
20229. Expiration April 30, 2023.
The ESTA logo is a registered trademark of the U.S. Department of Homeland Security. It's use, without
permission, is unauthorized and in violation of trademark law. For more information, or to request the use of the
logo, please go to help.cbp.gov (http://help.cbp.gov) and submit a request by clicking on "Ask a Question."
When selecting the Product (under Additional Information) use "ESTA" and the sub-product "Logo Assistance" to
expedite handling of your request.

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APPLICATION NUMBER EXPIRATION DATE

Family Name First (Given) Name Passport Number

Issuing Country Issuance Date Expiration Date

Country of Citizenship / National Identiﬁcation Number Personal Identiﬁcation Number

Sex Date of Birth City of Birth

Are you now, a citizen or national of any other country? No

Have you ever been a citizen or national of any other country? No

E-mail Address Conﬁrm E-mail Address

Are you known by any other names or aliases? No

YOUR CONTACT INFORMATION

Address Line 1 Address Line 2 Apartment Number

City State/Province/Region Country

Telephone Type Country Code Phone Number

SOCIAL MEDIA (OPTIONAL)

Family Name First (Given) Name

Family Name First (Given) Name

Do you have a current or previous employer? Yes

Job Title Employer Name

Address Line 1 Address Line 2

City State/Province/Region Country

Country Code Phone Number

Is your travel to the US occurring

U.S. Point of Contact Information

Address Line 1 Address Line 2 Apartment Number

Country Code Phone Number

Address While in the U.S.

Address Line 1 Address Line 2 Apartment Number

EMERGENCY CONTACT INFORMATION IN OR OUT OF THE U.S.

Family Name First (Given) Name E-mail Address

Country Code Phone Number

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