Application For Non-Immigration Visa Form
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1
2FA FORM 2A
Philippine Consulate Ireland
(Revised 12/03/2016)
APPLICATION FOR NON-IMMIGRATION VISA
Read the instructions carefully. Your application will not be processed in case of error or non-submission of requirements.
1
Name: ______________________________________________________________________________________
First Name
Middle Name
Surname
2 Date of Birth: _______________________
2a Place of Birth__________________________________________
3 Age: ____________ Sex:
Male
Female
3a. Email address: ______________________________
4 Marital Status:
Single
Married
Widow/er
Separated/Divorced
4a. Spouse:_____________________
5
Present Address in Ireland: ______________________________________________________________________
6
Citizenship: _________________________ Telephone No.: ____________________________________________
7
Occupation & Employer: ________________________________________________________________________
8
Passport (Country) _____________________________ Passport Number: ________________________________
Place of Issue: _________________________ Date of Issue: ___________________ Valid Until: _____________
9
Purpose of Entry: _________________________________________ Length of Intended Stay: _______________
10 Intended Area/s or City/s of Stay
(Add addition page if required) _____________________________________________________________________
11 Expected Date in the Philippines. i) Arrival ______________________ ii) Departure _______________________
12 Means of Financial Support / Funds: _______________________________________________________________
13 Have you provided evidence of Financial Support / Funds to cover the duration of your intended stay? Yes
No
14 Have you provided evidence of flight and accommodation details?
Yes
No
15 Number of visits to the Philippines in the past 5 years: _________________________________________________
16 Name & Address of Reference in the Philippines
________________________________________________
(If any):
17 Next Destination after the Philippines: ______________________________________________________________
18 Were you ever refused any kind of VISA, denied admission into or deported at government expense from the
Philippines?
NO
YES, if yes, state circumstances
_____________________________________________
19 Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or
other legal action?
NO
YES, if yes, state circumstances
_________________________________________
20 Have you ever been afflicted with a communicable disease of public health significance, a dangerous physical
or mental disorder, or been a drug abuser or addict?
NO
YES.
I understand that I may only enter the Philippines at a port of entry designated by The Philippine Immigration authorities and
with the permission of and under the conditions, including the giving of a bond, imposed by those authorities.
I SOLEMNLY SWEAR that the foregoing statements are true to the best of my knowledge and belief.
PASTE / GLUE
ONE RECENT
Signature of Applicant
PASSPORT
SUBSCRIBED AND SWORN to before me on ______________________ in the
PHOTO
City of __________, Ireland.
SIGNED ON THE
BOTTOM FRONT
____________________________________
Signature of:
Notary Public/Commissioner of Oaths/Peace Commissioner
FOR OFFICIAL USE ONLY:
VISA NO. _________________________ granted on ________________________________ as non-immigrant under Section 9( ) of
the Philippine Immigration Act of 1940, as amended, valid until _____________________________________.
Fee: ____________________________________________ Classification ____________________________________________________
Single
Multiple
O.R. No.: _____________________________________ Type of Entry:
Service No.: _____________________________
RECEIVED BY:
Name
Signature
Date
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