Application For Quota / Nonquota Immigrant Visa Page 2
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322. State the basis for your claim as
preference quota immigrant
non-quota immigrant :
23. Were you ever refused a visa of any kind by any Philippine diplomatic or consular Post?
Yes
No
If yes, state where, when and reason:
24. Were you ever refused any kind of Philippine visa, denied admission into or deported from the Philippines,
and/or removed at government expense from the Philippines and/or other countries?
Yes
No
If yes, state circumstances:
I understand that I may enter the Philippines at the Port of Entry designated by Philippine immigration
authorities and under the conditions imposed by those authorities.
I SOLEMNLY SWEAR that the foregoing statements are true to the best of my knowledge.
…………………………
………………………..….………………
Date
Signature of Applicant
SUBSCRIBED AND SWORN TO before me this _____ day of __________________ 20____ at the Philippine
Embassy, Berlin, Germany.
Doc. no.: __________
Book no.: __________
Page no.: __________
Series of: __________
Service no.: _________
……………………..……..….………………
O.R. no.: __________
Consul of the Republic of the Philippines
(Seal)
Date:
__________
Fee paid: __________
(For Official Use Only)
Immigrant Visa no. _______________
Quota Immigrant no. __________
Non-Quota Immigrant under Section _______ of the Philippine Immigration Act of 1940, as amended.
Issued on ____________________ and valid until ____________________.
Bearer has the following travel document:
Type: ______________________________ No.: ____________________ Date of Issue: ___________________
Issued by: __________________________________________________ Valid until: ______________________
Service no.: _________
O.R. no.: __________
………………………..…..….………………
Date:
__________
Consul of the Republic of the Philippines
(Seal)
Fee paid: __________
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