VCU Form 3

THIS FORM IS NOT FOR SALE,

REPRODUCTION IS ALLOWED
Jan. 2007

CERTIFICATION REQUEST FOR TRAVEL RECORDS

(Please Print your Answer)
Date : __________, 20____
DATE / TIME
THE COMMISSIONER
NOTE : RECEIVED
VCU window
BUREAU OF IMMIGRATION The Passenger Manifest of Arrival/Departure
INTRAMUROS, MANILA (below 1993) proceed to Records Section (3rd Floor,
Room 301). ______________
Dear Commissioner ;

May I request for a certification for travel records of subject :

SURNAME
FIRSTNAME
MIDDLE NAME
OTHER NAME
Please Check the approximate box :

EMBASSY PURPOSES COURT/LEGAL PURPOSES

_____________________________________________________ _____________________________________________________
( write embassy ) ( filing court / branch / contact # )

FOUNDATIONS
(please check the box) GREENLIFE PHIL.JAPAN TECO STEP OTHERS
____________________

OTHER INFORMATION
SEX (please check one) M F
Month Day Year
DATE OF BIRTH / /
PLACE OF BIRTH
NATIONALITY
PHILIPPINE ADDRESS

PASSPORT NO.
TEL. NO./CELL NO.

ARRIVAL DATE FLIGHT NUMBER DEPARTURE DATE FLIGHT NUMBER

DO NOT FILL THIS PORTION (FOR EMPLOYEE’S ONLY)

Very truly yours,
NO RECORD ON FILE NOTE
[for COMPUTER SECTION-VCU only] [for RECORDS SECTION only]
SIGNATURE of Requesting Party
ARRIVAL : FROM: _________________________

TO: __________________________
PRINTED NAME of Requesting Party
DEPARTURE : FROM : __________________________

TO: ___________________________

Verified by : _________________ Date / Time : ________________

NOTE : Please see BACK PAGE for LIST OF DOCUMENTARY REQUIREMENTS for submission.

VCU Form 3
Bureau of Immigration
Verification & Certification Unit DATE / TIME FILED:

CLAIM STUB
for travel cert. DATE / TIME released : [

Name of Subject : ___________________________________________________________

Date of Birth : __________________ Nationality : __________________________

 2 to 3 hours processing upon payment depending on the volume of application

 Always present this receipt upon claiming your certificate
 Unclaimed certificate shall be automatically cancelled after 30 days from the date of issuance
 If not the claimant of certificate, present any valid ID Cards

FRONT PAGE
SPECIFIC REQUIREMENTs :

EMBASSY PURPOSES :

 Attached xerox copy of PASSPORT

 (Optional) one xerox valid ID

COURT /LEGAL PURPOSES :

 Attached LETTER REQUEST from requesting office
 & one xerox valid ID

FOUNDATIONS :

 Attached xerox copy of passport

 (optional) one xerox valid ID

CERTIFICATION FEE’S :

Certification 500.00
Legal Research 10.00
Express Fee 500.00
TOTAL Ph P 1,010.00

Collected under C.A. No. 613,

Section 42(A)(19)
With MEMORANDUM ORDER NO. 02-045 dated 26 September 2002

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