Application For Non-Immigrants
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A Form No. 2 (Revised 1981)
FOREIGN SERVICE OF THE PHILIPPINES
EMBASSY OF THE PHILIPPINES
Applicant’s
JAKARTA, INDONESIA
Photo
APPLICATION FOR NON-IMMIGRANTS
___________________________________________________________________________________________________________
Surname
First Name
Middle Name
____________________________________________________________________________________________________________________
Date of Birth
Age:
Sex:
( ) Male
( ) Female
___________________________________________________________________________________________________________________
Place of Birth
Citizenship
____________________________________________________________________________________________________________________
Civil Status: ( ) Single ( ) Separated ( ) Married ( ) Divorced ( ) Widowed
Name of Spouse: _______________________________
Applicant’s Address
Contact Number & E-Mail Address:
___________________________________________________________________________________________________________________________________
Occupation
Name of Company:
Telephone No.:
___________________________________________________________________________________________________________________________________
Names and Ages of Children
___________________________________________________________________________________________________________________________________
Father’s Name
Mother’s Name
_______________
__
_______________________________________________________________________________________________________________
Description of Travel Document
Type
No.
Date Issued
Issued By
Valid Until
____________________________________________________________________________________________________________________
Other persons traveling to the Philippines with applicant under the same or separate travel documents
__________________________________________________________________________________________________________________________________
Port of Entry
Purpose of Entry
Length of Stay
___________________________________________________________________________________________________________________________________
Address in the Philippines
___________________________________________________________________________________________________________________________________
Reference/s in the Philippines
Name
Address
Contact Number
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Destination after the Philippines ________________________________________________________________________________________
Supporting documents offered for inspection
___________________________________________________________________________________________________________________________________
Were you ever refused any kind of visa for, denied admission into or deported/removed at government expense from the Philippines?
( ) No
( ) Yes (State
circumstances)________________________________________________________________________________________________________
I understand that I may 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 bond, imposed by those authorities.
I solemnly swear that the foregoing are true to the best of my knowledge and belief.
_____________________________________________
Signature of Applicant
Date:
Subscribed and sworn to before me this
day of
_________
_________________, _________.
_________________________________________
Notary Public/Commissioner of Oaths
___________________________________________________________________________________________________________________________________
(For Official Use Only)
Visa No. _______________ granted on ______________________________________as non-immigrant under Section
________________of the Philippine Immigration Act of 1940, as amended.
Valid until __________________________________.
___________________________________
Consul of the Republic of the Philippines
Fee Paid
: Rp _______________
O.R. No.
:
_______________
Service No. :
_______________
AMOUNT RECEIVED: Rp ___________________________ >VISA _____
CHANGE: Rp _________________
> OT _____
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