ESTA Application Approved

https://esta.cbp.dhs.gov/esta/jsp/print/printApp.jsp?appInum=R793R979XRQK27CK&print=true

Authorization Approved

Official Website of the Department of Homeland Security

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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

R793R979XRQK27CK Oct 4, 2021

Payment Receipt

Payment Date October 4, 2019

Payment Tracking Code 26KKRBCS

Payment Received $14.00

Applicant Information

Family Name First (Given) Name

CHIEN YI SEN

Are you known by any other names or aliases? No

Date of Birth Gender

Sep 15, 2008 M (Male)

City of Birth Country of Birth

TAIPEI CITY TAIWAN (TWN)

PARENTS

Family Name First (Given) Name

CHIEN CHENG-TAI

Family Name First (Given) Name

LIN HSING-HUA

Passport Information

Passport Number Issuing Country

314413880 TAIWAN (TWN)

Issuance Date Expiration Date

Feb 2, 2017 Feb 2, 2022

Issuing Country National Identification Number

TAIWAN (TWN) A132245221

Personal Identification Number A132245221

Have you ever been issued a passport or national identity card for travel by any other country? No

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

GE MEMBERSHIP

Are you a member of the CBP Global Entry Program? No

YOUR CONTACT INFORMATION

E-mail Address

ethanyyii@gmail.com

Telephone Number

Telephone Type Country Code + Phone / Number

Mobile TAIWAN (TWN) (+886) / 906877915

Home Address

Address Line 1 Apartment Number

NO. 18, LN. 256, XIANGNAN RD

Address Line 2 City

DONGSHAN TOWNSHIP

State/Province/Region Country

YILAN COUNTY TAIWAN (TWN)

Social Media (Optional)

Emergency Contact

Emergency Contact

Family Name First (Given) Name

CHIEN CHENG-TAI

Telephone Number

Country Code + Phone Number

TAIWAN (TWN) (+886) 927611419

E-mail Address

iphoneuse@gmail.com

Travel Information

Is your travel to the US occurring in transit to another country? No

Address While in the U.S.

Address Line 1 Apartment Number

Address Line 2 City

State

U.S. Point of Contact Information

HYATT PLACE LOS ANGELES/LAX/EL SEGUNDO

Address

Address Line 1 Apartment Number

750 N NASH ST

Address Line 2 City

EL SEGUNDO

State

CALIFORNIA

Telephone Number

Country Code + Phone Number

UNITED STATES (USA) (+1) 3103222880

EMPLOYMENT INFORMATION

Do you have a current or previous employer? No

ELIGIBILITY QUESTIONS

1) Do you have a physical or mental disorder; or are you a drug 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, Crimean-Congo
Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.
No

2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority? No

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 genocide? No

5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States? No

6) Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government? No

7) Have you ever been denied a U.S. visa you applied for with your 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? No

If yes:

when

where

8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government? No

9) Have you traveled to, or been present in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011? No

Application Number	Expiration Date
R793R979XRQK27CK	Oct 4, 2021

Payment Date	October 4, 2019
Payment Tracking Code	26KKRBCS
Payment Received	$14.00

Family Name	First (Given) Name
CHIEN	YI SEN
Are you known by any other names or aliases?	No

Date of Birth	Gender
Sep 15, 2008	M (Male)
City of Birth	Country of Birth
TAIPEI CITY	TAIWAN (TWN)

Family Name	First (Given) Name
CHIEN	CHENG-TAI

Family Name	First (Given) Name
LIN	HSING-HUA

Passport Number	Issuing Country
314413880	TAIWAN (TWN)
Issuance Date	Expiration Date
Feb 2, 2017	Feb 2, 2022
Issuing Country	National Identification Number
TAIWAN (TWN)	A132245221
Personal Identification Number	A132245221
Have you ever been issued a passport or national identity card for travel by any other country?	No

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

Are you a member of the CBP Global Entry Program?	No

E-mail Address
ethanyyii@gmail.com
Telephone Number
Telephone Type	Country Code + Phone / Number
Mobile	TAIWAN (TWN) (+886) / 906877915
Home Address
Address Line 1	Apartment Number
NO. 18, LN. 256, XIANGNAN RD
Address Line 2	City
	DONGSHAN TOWNSHIP
State/Province/Region	Country
YILAN COUNTY	TAIWAN (TWN)

Emergency Contact
Family Name	First (Given) Name
CHIEN	CHENG-TAI
Telephone Number
Country Code + Phone	Number
TAIWAN (TWN) (+886)	927611419
E-mail Address
iphoneuse@gmail.com

Is your travel to the US occurring in transit to another country?	No
Address While in the U.S.
Address Line 1	Apartment Number

Address Line 2	City

State

U.S. Point of Contact Information
HYATT PLACE LOS ANGELES/LAX/EL SEGUNDO
Address
Address Line 1	Apartment Number
750 N NASH ST
Address Line 2	City
	EL SEGUNDO
State
CALIFORNIA
Telephone Number
Country Code + Phone	Number
UNITED STATES (USA) (+1)	3103222880

1) Do you have a physical or mental disorder; or are you a drug 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, Crimean-Congo Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.	No
2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority?	No
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 genocide?	No
5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?	No
6) Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government?	No
7) Have you ever been denied a U.S. visa you applied for with your 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?	No

If yes:
when
where

8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?	No
9) Have you traveled to, or been present in Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011?	No

Regards,

Clark Chien

Account Management

✆: +886-2-6612-2821 | Mobile: +886-927-611-419 (Speed dial: 8010-2821)

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