Immigrant Visa Application Form (Philippines) Page 2
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225. OCCUPATION
26. NAME AND ADDRESS OF EMPLOYER IN THE PHILIPPINES
27. ADDRESS IN THE PHILIPPINES WHERE THE APPLICANT INTENDS TO SETTLE (include apartment number, street, city, state or province, postal zone )
28. ON WHAT BASIS DO YOU CLAIM TO BE A
PREFERENCE QUOTA IMMIGRANT
NON-QUOTA IMMIGRANT?
( state basis of your claim )
29. HAVE YOU EVER BEEN CONVICTED OF ANY CRIME?
YES ( specify crime and date of conviction )
NO
30. HAVE YOU EVER BEEN REFUSED ANY KIND OF VISA FOR THE PHILIPPINES, DENIED ADMISSION INTO, DEPORTED OR REMOVED AT GOVERNMENT EXPENSE
FROM THE PHILIPPINES?
YES ( state circumstances and date of refusal/denied admission/deportation/removal )
NO
31. HAVE YOU EVER BEEN INSTITUTIONALIZED FOR ANY MENTAL DISORDER?
YES ( state particulars and date of institutionalization)
NO
32. HOW WILL YOU SUBMIT THIS APPLICATION?
PERSONAL
MAIL / COURIER
TRAVEL AGENCY / REPRESENTATIVE
Name of Travel Agency / Authorized Representative
33. DO YOU HAVE ANY PHYSICAL DEFECT OR CONTAGIOUS DISEASE?
YES ( state defect or disease and other particulars)
NO
IMPORTANT:
IF APPLICANT IS UNABLE TO APPLY IN PERSON THIS FORM SHALL BE NOTARIZED
34.
I understand that I may enter the Philippines at the port of entry designated by the Philippine Immigration Authorities under the conditions
imposed by those authorities.
I solemnly swear under penalty of law that the foregoing statements are true and correct and the attached supporting
documents are authentic.
Signature of Applicant Over Printed Name
SUBSCRIBED AND SWORN to before me this
day of
, CY
.
,
at
Notary Public
Consul of the Republic of the Philippines
FOR OFFICIAL USE ONLY
.
Doc. No.
REMARKS
Series
Service No.
O.R. No.
Fee
TRAVEL DOCUMENT RELEASED TO
PRINTED NAME AND SIGNATURE
DATE RECEIVED / MAILED
MAIL/COURIER TRACKING NO.
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