NON-IMMIGRANT VISA

Surname:

First Name:

Middle Name:

Sex:

Male Female

Citizenship:

Civil Status:

Date of Birth:

Place of Birth:

Spouse Name: (if married)

Spouse Address: (if married)

Applicant’s Address:

Since:

Occupation:

Since:

Telephone No. :

Child1 Name:

Age:

Child2 Name:

Age:

Child3 Name:

Age:

Child4 Name:

Age:

Father’s Name:

Mother’s Name:

Description of Passport or Travel Document:

Type:

No.:

Issued by:

Date of Issue:

Valid Until:

Port of Entry:

Purpose of Entry:

Length of Stay:

Other person(s) traveling with applicant under the same passport or travel document:

person(s):

Address in the Philippines:

References in the Philippines:

1- Name

1-Address:

2- Name

2-Address:

Destination in the Philippines:

Supporting Documents submitted and offered for inspection in support of visa applicant:

Were you ever refused any kind of Philippine visa before, denied admission into or deported
from the Philippines ? Yes No

If yes, state the circumstances: