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Family / Last name * *

First name * *

Middle name (if any)

Gender * *MaleFemale

Date of Birth (DD/MM/YYYY) * *

City/Town of Birth * *

Country of Birth * *

Country of Eligibility * *

In Care Of (if any)

Street *

Apartment, suite, etc.

City

ZIP / Postal code

Country where you live today * *

Phone number (optional)

Email Address * *

Highest level of education achieved * *

Marital Status * *SingleMarried — spouse is not a US citizen/PRMarried — spouse is a US citizen/PRDivorcedWidowedLegally separated

Spouse — Family/Last Name * *

Spouse — First Name * *

Spouse — Middle Name

Spouse — Date of Birth (DD/MM/YYYY) * *

Spouse — Gender * *MaleFemale

Spouse — City/Town of Birth * *

Spouse — Country of Birth * *

Spouse Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Number of children * *

Child 1 — Family/Last Name * *

Child 1 — First Name * *

Child 1 — Date of Birth (DD/MM/YYYY) * *

Child 1 — Gender * *MaleFemale

Child 1 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 2 — Family/Last Name * *

Child 2 — First Name * *

Child 2 — Date of Birth (DD/MM/YYYY) * *

Child 2 — Gender * *MaleFemale

Child 2 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 3 — Family/Last Name * *

Child 3 — First Name * *

Child 3 — Date of Birth (DD/MM/YYYY) * *

Child 3 — Gender * *MaleFemale

Child 3 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 4 — Family/Last Name * *

Child 4 — First Name * *

Child 4 — Date of Birth (DD/MM/YYYY) * *

Child 4 — Gender * *MaleFemale

Child 4 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 5 — Family/Last Name * *

Child 5 — First Name * *

Child 5 — Date of Birth (DD/MM/YYYY) * *

Child 5 — Gender * *MaleFemale

Child 5 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 6 — Family/Last Name * *

Child 6 — First Name * *

Child 6 — Date of Birth (DD/MM/YYYY) * *

Child 6 — Gender * *MaleFemale

Child 6 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 7 — Family/Last Name * *

Child 7 — First Name * *

Child 7 — Date of Birth (DD/MM/YYYY) * *

Child 7 — Gender * *MaleFemale

Child 7 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 8 — Family/Last Name * *

Child 8 — First Name * *

Child 8 — Date of Birth (DD/MM/YYYY) * *

Child 8 — Gender * *MaleFemale

Child 8 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 9 — Family/Last Name * *

Child 9 — First Name * *

Child 9 — Date of Birth (DD/MM/YYYY) * *

Child 9 — Gender * *MaleFemale

Child 9 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Child 10 — Family/Last Name * *

Child 10 — First Name * *

Child 10 — Date of Birth (DD/MM/YYYY) * *

Child 10 — Gender * *MaleFemale

Child 10 Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

Drag and Drop (or) Choose Files

Applicant Photo * *JPEG only, ≤240KB, 600×600px, white background, no glasses, taken within the last 6 months.

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Declaration * *I declare that all information is true and complete

Privacy & Consent * *I consent to processing my personal data for DV Lottery application

Payment method * *Card (Stripe)PayPal

Card payment (Stripe) *Pay with card via Stripe ($99.99)

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