Application For Non Immigrant Visa Page 2
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2
3Have you been convicted of any crime? [
] No [
] Yes. Please provide details.
______________________________________________
Have you been issued a Philippine visa before? [
] No [
] Yes. Latest visa number issued: ________________
Date of Issue _________________
Do you have any communicable disease? [
] No
[
] Yes. Please provide details. ________________________
Do you have a history of mental illness? [
] No
[
] Yes. Please provide details. _________________________
Were you ever refused any kind of Philippine visa, denied admission into or deported from the Philippines and removed
at government expense from the Philippines and other countries?
[
] No
[
] Yes. Please provide circumstance __________________________________________
For those applying for a Philippine visa through a travel agent or representative.
Name of Travel Agent/ Representative: ________________________________________________
Contact details _______________________________________________________________________
o
I agree that any false or misleading statement and submission of fraudulent documents will result in the refusal
of a visa.
o
I agree to submit documents in addition to those submitted as indicated in the List of Submission of Required
Documents, if required.
o
I agree that submission of compete documentary requirements is not a guarantee that a visa will be issued.
o
I agree that since my application will go through the visa processing procedure, the processing visa fee that I
will pay will not be refunded even if no visa is issued to me.
o
I agree that the possession of a visa does not automatically entitle the bearer to enter the Philippines upon
arrival at any port or entry if he or she is found inadmissible.
o
I agree that I may enter the Philippines at the port of entry designated by the Philippine Immigration Authorities
and under the conditions imposed by those authorities.
o
I have read and understood all the questions in this application form and the answers I have furnished on this
form are true and correct to the best of my knowledge and belief.
_________________________
______________________________
DATE
SIGNATURE OF APPLICANT
FOR OFFICIAL USE ONLY
Dear Applicant:
You are requested to submit additional requirements to establish you as a qualified applicant for the
visa category you have applied for within 5 working days upon receipt of notice from the Philippine
Embassy, New Delhi.
Your credentials have not established you as a qualified applicant for the visa category you have
applied for.
For more information on Philippine visa matters, please visit
.
September 20, 2009
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