ESTA Application

04/05/2017 ESTA Application
Official Website of the Department of Homeland Security
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AUTHORIZATION PENDING
Your travel authorization is under review because an immediate determination could not be made. This response does not indicate
negative findings. A determination will be available within 72 hours. Return to this website to retrieve and view the ESTA status of a
previously submitted authorization for one or for a group of two or more persons.
APPLICATION NUMBER: RW7WR9R9R8QT4424
APPLICANT INFORMATION
FAMILY NAME FIRST (GIVEN) NAME
PELIZZO GIANNI
Are you known by any other names or No
aliases?
DATE OF BIRTH GENDER
Jul 31, 1971 M (Male)
CITY OF BIRTH COUNTRY OF BIRTH
UDINE ITALY
PARENTS
FILIPPIG EDDA
PELIZZO DARIO
PASSPORT INFORMATION
PASSPORT NUMBER ISSUING COUNTRY
YB0856063 ITALY
ISSUANCE DATE EXPIRATION DATE
Apr 20, 2017 Apr 19, 2027
COUNTRY OF CITIZENSHIP
ITALY
HAVE YOU EVER BEEN ISSUED A No
PASSPORT OR NATIONAL IDENTITY
CARD FOR TRAVEL BY ANY OTHER
COUNTRY?
OTHER CITIZENSHIP/NATIONALITY
https://esta.cbp.dhs.gov/esta/jsp/print/printApp.jsp?appInum=RW7WR9R9R8QT4424&print=true 1/4
ARE YOU NOW, A CITIZEN OR No
NATIONAL OF ANY OTHER COUNTRY?
HAVE YOU EVER BEEN A CITIZEN OR No
NATIONAL OF ANY OTHER COUNTRY?
GE MEMBERSHIP
ARE YOU A MEMBER OF THE CBP No
GLOBAL ENTRY PROGRAM?
YOUR CONTACT INFORMATION
EMAIL ADDRESS
gianni.pelizzo@gmail.com
TELEPHONE NUMBER
TELEPHONE TYPE COUNTRY CODE + PHONE / NUMBER
MOBILE 39 / 3485618230
HOME ADDRESS
ADDRESS LINE 1 APARTMENT NUMBER
VIA PIRANDELLO, 37
ADDRESS LINE 2 CITY
CARBONERA
STATE/PROVINCE/REGION COUNTRY
TREVISO ITALY
SOCIAL MEDIA (OPTIONAL)
EMERGENCY CONTACT
EMERGENCY CONTACT
CERICCO VANI
TELEPHONE NUMBER
COUNTRY CODE + PHONE NUMBER
39 3406646255
EMAIL ADDRESS
vani.cericco@gmail.com
TRAVEL INFORMATION
IS YOUR TRAVEL TO THE US NO
OCCURRING IN TRANSIT TO ANOTHER
COUNTRY?
ADDRESS WHILE IN THE U.S.
201 E DELAWARE PL
ADDRESS LINE 2 CITY
CHICAGO
STATE
IL
U.S. POINT OF CONTACT INFORMATION
HOTEL RAFFAELLO
ADDRESS
201 E DELAWARE PL
ADDRESS LINE 2 CITY
CHICAGO
STATE
IL
TELEPHONE NUMBER 13129435000
EMPLOYMENT INFORMATION
DO YOU HAVE A CURRENT OR YES
PREVIOUS EMPLOYER?
EMPLOYER NAME TECHEDGE GROUP SPA
JOB TITLE DIRECTOR
ADDRESS
ADDRESS LINE 1
VIA CALDERA 22
ADDRESS LINE 2 CITY
MILANO
STATE COUNTRY
MI ITALY
TELEPHONE NUMBER
COUNTRY CODE + PHONE NUMBER
39 0287311
ELIGIBILITY QUESTIONS
1) DO YOU HAVE A PHYSICAL OR MENTAL DISORDER; OR ARE YOU A DRUG No
ABUSER OR ADDICT; OR DO YOU CURRENTLY 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,
CRIMEANCONGO
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 No
RESULTED IN SERIOUS DAMAGE TO PROPERTY, OR SERIOUS HARM TO
ANOTHER PERSON OR GOVERNMENT AUTHORITY?
3) HAVE YOU EVER VIOLATED ANY LAW RELATED TO POSSESSING, USING, OR No
DISTRIBUTING ILLEGAL DRUGS?
4) DO YOU SEEK TO ENGAGE IN OR HAVE YOU EVER ENGAGED IN TERRORIST No
ACTIVITIES, ESPIONAGE, SABOTAGE, OR GENOCIDE?
5) HAVE YOU EVER COMMITTED FRAUD OR MISREPRESENTED YOURSELF OR No
OTHERS TO OBTAIN, OR ASSIST OTHERS TO OBTAIN, A VISA OR ENTRY INTO
THE UNITED STATES?
6) ARE YOU CURRENTLY SEEKING EMPLOYMENT IN THE UNITED STATES OR No
WERE YOU PREVIOUSLY EMPLOYED IN 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 No
CURRENT OR PREVIOUS PASSPORT, OR HAVE YOU EVER BEEN REFUSED
ADMISSION TO THE UNITED STATES OR WITHDRAWN YOUR APPLICATION FOR
ADMISSION AT A U.S. PORT OF ENTRY?
IF YES:
WHEN
WHERE
8) HAVE YOU EVER STAYED IN THE UNITED STATES No
LONGER THAN THE ADMISSION PERIOD GRANTED TO
YOU BY THE U.S. GOVERNMENT?
9) HAVE YOU TRAVELED TO, OR BEEN PRESENT IN IRAQ, No
SYRIA, IRAN, SUDAN, LIBYA, SOMALIA OR 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
16510111. 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 Sep 30, 2018.
The ESTA logo is a registered trademark of the U.S. Department of Homeland Security. Its 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 and submit a
request by clicking on "Ask a Question." When selecting the Product (under Additional Information) use "ESTA" and the subproduct
"Logo Assistance" to expedite handling of your request.

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04/05/2017 ESTA Application

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