Revised 12 December 2012

FA Form No. 2 A

Republic of the Philippines PHOTO

Foreign Service fo the Philippines
Philippine Embassy in Wellington, NZ
APPLICATION FOR NON-IMMIGRANT VISA TO THE PHILIPPINES
TYPE OR PRINT IN BLOCK LETTERS LEGIBLY. PLEASE COMPLETE ALL ENTRIES TO AVOID DELAY.
Surname First Name

Place of Birth Date of Birth(MM/DD/YR) Age Citizenship Sex

Male Female
Applicant's Address Telephone No.

Occupation Office of Employment and Address Telephone No.

Father's Name Mother's Name

Civil Status If Married name of Spouse Citizenship
Single Separated Name and ages of Children, if any
Married Divorce/ Name and address of sponsor/reference in the Philippines Tel No.
Widowed Annulled
Passport/Travel Document no. Date of Issue Valid until Issued by

Arrival Date in the Philippines Length of stay Port of Entry Purpose of Entry

Name of travelling companion (for minor applicant) Destination after the Philippines

Have you ever been issued a Philippine visa? Yes No

Latest visa no. ______________ Type of visa ______________ Issued on ________ Issued by _________
Latest Entry Date _____________ Latest Exit Date ___________ Duration of last stay in the Philippines ________
Documents submitted in support of application
Valid passport/travel document Chinese ID No. Affidavit of support & guarantee
Household Registry Air Ticket (for travel agency only)
Financial proof Others (specify)_____________ Invitation letter
1. Were you ever refused any kind of Philippine visa before and denied into or deported from the Philippines?
Yes No If yes, state circumstances _________________________________
2. Have you ever been arrested or convicted for any offense or crime, even through subject of a pardon, amnesty, or other
legal action? Yes No If yes, state circumstances ______________________
_________________________________________________________________.
3. Have you ever been afflicted with a communicable disease of public health significance, dangerous physical or mental
disorder, or been a drug abuser or addict? Yes No If yes, state circumstances
_________________________________________________________________.
I understand that I may only enter the Philippines at the Port of Entry designated by the Philippine Immigration Authorities
and under the condition imposed by those authorities.
I solemnly swear that the foregoing statements are true to best of my knowledge.
Warning: (1) Drug trafficking is punishable under Philippine law.
(2) Tourist are not allowed to engage in any pedding activity. _____________________________________
Violators will be subject to deportation. APPLICANT'S SIGNATURE/DATE
_________________________________________________________________________________________________
SUBSCRIBED AND SWORN to before me this (day)______________________.

JUSTICE OF THE PEACE

_________________________________________________________________________________________________
DO NOT FILL OUT BELOW THIS LINE (FOR OFFICIAL USE ONLY)
Visa No. Granted on: As Non-Immigrant Under Sec. 9(a,c,e),13 (a,g) of the Philippine Immigration
Act of 1940, as amended:
Valid Until:
Consul of the Republic of the Philippines
Processed & Verified by: SN# Fee: NZ$ OR#