Please affix signature on the front side of For official use only: picture. Do not attach scanned pictures.
[ [
] Male ]Female
Nationality
] Single [
] Married
] Widowed [
] Separated
] Divorced
Names of Children Name of Father Name of Mother If less than 15 years old, name and relationship of traveling companion: Home Address of Applicant
Since
Telephone No:
Mobile No:
Since
Telephone No:
Designation of Applicant
Passport Number
Valid until
Place of Issue
Duration of Stay
Number of Entries Applied for Date of Arrival in the Philippines (day, month, year)
Single entry[
For temporary visitors visa and transit visa holders: Please present to the Philippine immigration officer your return or onward journey plane ticket.
Address in Philippines
Telephone Number
www.newdelhipe.com.
June 28, 2013
For business visa applicants, will you extend your stay in the Philippines by converting to 9(g), 9(f) or 47(a-2)? [ ] No [ ] Yes. If yes, please explain. _______________________________________________________________________________________ Have you been convicted of any crime? [ ] No [ ] Yes. Please provide details. ______________________________________________ Have you been issued a Philippine visa before? [ Date of Issue _________________ Do you have any communicable disease? [ Do you have a history of mental illness? [ ] No ] No [ ] No [ ] Yes. Latest visa number issued: ________________
] Yes. Please provide details. ________________________ ] Yes. Please provide details. _________________________
Were you ever refused any kind of Philippine visa, denied admission into or deported from the Philippines and removed at government expense from the Philippines and other countries? [ ] No [ ] Yes. Please provide circumstance __________________________________________
For those applying for a Philippine visa through a travel agent or representative. Name of Travel Agent/ Representative: ________________________________________________ Contact details _______________________________________________________________________
o o
I agree that any false or misleading statement and submission of fraudulent documents will result in the refusal of a visa. I agree to submit documents in addition to those submitted as indicated in the List of Submission of Required Documents, if required.
o o
I agree that submission of compete documentary requirements is not a guarantee that a visa will be issued.
I agree that since my application will go through the visa processing procedure, the processing visa fee that I will pay will not be refunded even if no visa is issued to me.
I agree that the possession of a visa does not automatically entitle the bearer to enter the Philippines upon arrival at any port or entry if he or she is found inadmissible.
I agree that I may enter the Philippines at the port of entry designated by the Philippine Immigration Authorities and under the conditions imposed by those authorities.
I have read and understood all the questions in this application form and the answers I have furnished on this form are true and correct to the best of my knowledge and belief.
_________________________ DATE
Dear Applicant:
You are requested to submit additional requirements to establish you as a qualified applicant for the visa category you have applied for within 5 working days upon receipt of notice from the Philippine Embassy, New Delhi. Your credentials have not established you as a qualified applicant for the visa category you have applied for. For more information on Philippine visa matters, please visit
www.newdelhipe.com.
June 28, 2013
Latest Bank Statements (For the last six months) Processing fee in demand draft drawn from any bank in India payable to Embassy of the Philippines. The Embassy may require other documents to confirm certain circumstances relating to the applicants stay in the Philippines;
www.newdelhipe.com.
June 28, 2013