First Name*

Middle Name

Last Name*

Date of Birth*

Gender*

City of Birth*

Country of Birth*

Email Address*

Phone Number*

Address*

City*

Country*

Education Level*

Status*

Number of Children

Requirements: Recent photo, white background, 600x600px minimum Photo will be cropped to 600x600 pixels as per DV lottery requirements.

Click to select photoMax 4MB, will be cropped to 600x600px

Payment Information

Please transfer the amount to the account shown above and upload your receipt

Select Bank *

Have a coupon code?

Upload Payment Receipt *

Click to upload or drag and drop

Images or PDF (Max 4MB)

DV Lottery Application Form