A Form No. 2 (Revised 1981)
Other persons traveling to the Philippines with applicant under the same or separate travel documents
__________________________________________________________________________________________________________________________________
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 __________________________________.
AMOUNT RECEIVED: Rp ___________________________ >VISA _____ CHANGE: Rp _________________ > OT _____
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