طلب تسجيل

2. Gender *

Male

Female

Explanation about some Questions

11. (NOTE: This e-mail address will be used to provide you with additional information if you are selected.)

Our service fees:

Start at $19.99 for 1 entrant for one person

*Child/Children - Children must to be single and below age 21 year old

Free Entry for children with Parents

PAPERWORK REDUCTION ACT: Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: PRA_BurdenComments@state.gov.

CONFIDENTIALITY STATEMENT: The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation, amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be made available to a court which certifies that the information contained in such records is needed in a case pending before the court.

e. District/County/Province/State *

Are you claiming eligibility based on the country where you were born? *

Yes

Middle Name *

Early registration تسجيل مبكر

6. Country of Eligibility of the DV Program *

5. Country where you were born *

8. Mailing Address *

There is no cost to register for the DV Program. Our fees are for preparation your photographs and entering your information as soon as possible for required lottery period Application.

If there is marriage, each spouse can register separate entry, this way will double chance to win.

4. City where you were born *

c. Address Line 2 (optional)

يجب تقديم الطلب بالغة الانجليزية

This Application for the Year *

2019

2020

2021

b. Address Line 1 *

First Name *

14. Number of Children

Children include all biological children, legally adopted children, and stepchildren who are unmarried and under the age of 21 on the date you submit your entry. You must include all eligible children, even if they do not live with you or if they do not intend to apply for a Diversity Visa as your derivative. Failure to list all eligible children is grounds for disqualification. If your child is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.

13. What is your current marital status?

Unmarried

Married and my spouse is NOT a U.S.citizen or U.S. Lawful Permanent Resident (LPR)

Married and my spouse IS a U.S.citizen or U.S. Lawful Permanent Resident (LPR)

Divorced

Widowed

Legally Separated

g. Country *

لا تستطيع تقديم الطلب باللغة الانجليزية

ارجو الاتصال بنا

11. E-mail Address, (NOTE: This e-mail address will be used to provide you with additional information if you are selected.) *

13. Legal separation is an arrangement when a couple remain married but live apart, following a court order. If you and your spouse are legally separated, your spouse will not be able to immigrate with you through the Diversity Visa program; however, you must include your spouse even if you plan to be divorced before you apply for the Diversity Visa. Failure to list your eligible spouse is grounds for disqualification. If your spouse is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.

If not, you must enter the country from which you are claiming eligibility. *

f. Postal Code/Zip Code *

12. You must have a minimum of a high school diploma reflecting the completion of a full course of study (vocation schools or equivalency degrees are not acceptable) or be a skilled worker in an occupation that requires at least two years of training or experience to qualify (visit http://www.onetonline.org/ to see if your occupation qualifies) for a Diversity Visa.

7. Enter applicant Photograph

3. Birth Date: mm/dd/yyyy *

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1. Last / Family Name *

DVLa طلب تسجيل فى الوترى الجرين كارد لوترى

d. City/Town *

14. Number of Children

Entries for the DV program must be submitted electronically

تقديم الطلب الكترونيا عبر هذا الصفحة

مجانا

a. In Care Of (optional)

9. Country Where You Live Today *

10. Phone Number Optional *