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?)

Si vous avez des enfants/conjoint, veuillez fournir les mêmes informations pour eux dans la section membre ci-dessous.

Include member in the application?

Yes

Relation avec le demandeur principal

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.

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