Dv Lottery | Samfly

Main Application

First Name

Last Name

Date of Birth

City and Country of Birth

Nationality

Highest education:

Email address

Current Address

Matrimonial Status(Legally married?)

If you have children/Spouse please provide the same information for them in the member section below

Include member in the application?

Yes

Relationship with the main applicant

First Name

Last Name

Date of Birth

City and Country of Birth

Nationality

Highest education:

Email address

Current Address

Relationship with the main applicant

First Name

Last Name

Date of Birth

City and Country of Birth

Nationality

Highest education:

Email address

Current Address

By submitting this form, you acknowledge and agree that a non-refundable processing fee of $20 is required to file for the Diversity Visa (DV) Lottery for the United States. This fee is mandatory and must be paid upon form submission. Failure to pay the fee will result in the application not being processed. By checking the box, you confirm that you understand and accept this requirement.

Thanks for applying to volunteer with us! We'll get back to you soon.