BI FORM 2014-00-002 Rev 0 This document may be reproduced and is NOT FOR SALE

CONSOLIDATED GENERAL APPLICATION FORM

FOR NON-IMMIGRANT VISA, SPECIAL WORK PERMIT AND
PROVISIONAL WORK PERMIT [EXCEPT STUDENT VISA AND SSP]
Page 1 of 2

I. APPLICATION INFORMATION

Present Immigration Status

Nature of Application
Conversion Extension Inclusion

Permit
Type of Visa/Permit Application

Number of Months/Years Applied For
3 Months 1 Year

2 Years


3 Years

Method of Application

Personal Authorized Representative
BI Accreditation Number


Name of Authorized Representative [Last Name, First/Given Name, Middle Name]



Position in the Company/Institution

II. APPLICANTS TRAVEL INFORMATION
Passport Number Date of Latest Arrival [DD-MMM-YYYY e.g. 01 JAN 1990]

Expiry Date/Valid Until [DD-MMM-YYYY e.g. 01 JAN 1990] Flight Number

Place of Issuance Last Day of Authorized Stay [DD-MMM-YYYY e.g. 01 JAN 1990]

III. APPLICANTS PERSONAL INFORMATION
Last Name

First/Given Name

Middle Name

Other Name(s)/Alias(es)
1

2
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Gender Country of Birth

M F

Citizenship/Nationality Civil Status

Single Married Annulled

Height [cm]

Weight [kg]

Separated Widowed Divorced
Profession/Occupation

Contact Number(s) in the Philippines Email Address
Landline




Mobile



Residential Address in the Philippines Residential Address Abroad
House/Unit No., Street, Subdivision/Village House/Unit No., Street, Subdivision/Village

Barangay, Municipality/City City, State

Province, Zip Code Country, Zip Code

Name of Spouse [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es)
1

2

Name(s) of Child(ren) and Date(s) of Birth [Last Name, First/Given Name, Middle Name]
1

Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]

Last Name, First/Given Name, Middle Name
2

Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]

Note: If the applicant has more than two (2) children, use BI Form 2014-00-005 Rev 0
APPLICANTS ACR I-CARD CLAIM STUB
Applicants Name [Last Name, First/Given Name, Middle Name (Please leave a box after each name)]






ACR Number

Visa Type



[IF THE ACR I-CARD IS CLAIMED BY AN AUTHORIZED REPRESENTATIVE, PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS.]


Attach your 2x2 colored photograph
with white background using
permanent glue in the
photograph box.
The photograph must be taken
within the last three (3) months
from the date of application.
A scanned photograph is not
allowed. A photograph of the
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses,
etc.) or headwear is not acceptable.


BI FORM 2014-00-002 Rev 0 This document may be reproduced and is NOT FOR SALE
CONSOLIDATED GENERAL APPLICATION FORM
FOR NON-IMMIGRANT VISA, SPECIAL WORK PERMIT AND
PROVISIONAL WORK PERMIT [EXCEPT STUDENT VISA AND SSP]

Page 2 of 2
ACR I-CARD WILL ONLY BE RELEASED UPON COMPLIANCE/SUBMISSION OF THE FF:

1. Photocopy of passport bio-page of the ACR I-Card holder
2. Valid ID of either parent claiming the ACR I-Card, if applicant is a minor
3.Photocopy of the BI-Accreditation ID card, if claimed by a travel agent or law firm
4.Special Power of Attorney (SPA), if claimed by an authorized representative other than the
parent or BI accredited entity

ACR I-Card Holder: _________________________ Claimant:_____________________
Signature over PRINTED NAME Signature
[Please call (+632) 525-7557 to check the status of your application]
Name of Representative _________________________________
Accredited Travel Agency/Law Office _______________________
BI Accreditation No. _____________________________________
Contact No. ___________________________________________
Residential /Office Address _______________________________
Signature_____________________________________________

Character References in the Philippines
Last Name, First/Given Name, Middle Name
1


Residential Address in the Philippines
House/Unit No., Street, Subdivision/Village

Barangay, Municipality/City

Province, Zip Code

Last Name, First/Given Name, Middle Name
2


Residential Address in the Philippines
House/Unit No., Street, Subdivision/Village

Barangay, Municipality/City

Province, Zip Code

IV. PETITIONERS INFORMATION
Name of Institution



Registration Number

Nature of Institution

Commercial Religious Others [Please specify] ____________________________________________________________
Registered Address in the Philippines
House/Unit No., Street, Subdivision/Village

Barangay, Municipality/City

Province, Zip Code

V. APPLICANTS OTHER INFORMATION
Position in the Organization Expiration of Contract [DD-MMM-YYYY e.g. 01 JAN 1990]

Alien Employment Permit (AEP) Number Actual Monthly Gross Salary in Philippine Currency

AEP Expiry Date/Valid Until [DD-MMM-YYYY e.g. 01 JAN 1990]

VI. ACR I-Card
Alien Certificate of Registration (ACR) Number

Date of Issuance [DD-MMM-YYYY e.g. 01 JAN 1990]

Expiry Date/Valid Until [DD-MMM-YYYY e.g. 01 JAN 1990]

Certificate of Residence Number (CRN)




C E R T I F I C A T I O N

I/We certify that: (1) All the information in the application is truthful, complete and correct; (2) All documents
are authentic and were legally obtained from the corresponding government agencies or private entities; (3) I/We
understand that my/our application may be summarily denied if: (a) Any statement is false; (b) Any document
submitted is falsified; or (c) I/We fail to comply with all the BI requirements without prejudice to whatever action the
BI may take; and (4) I/We have not filed this or any similar application before any office of the Bureau.




____________________ ______________________________________ _____________________________________
Date [DD-MMM-YYYY Petitioners Signature over Printed Name Applicants Signature over Printed Name
e.g. 01 JAN 1990]







DO NOT FILL OUT THIS PORTION
Application Number


Received/Recommended by: _______________________________

Reviewed by: ___________________________________________

Approved by: ___________________________________________



Contact Number(s) in the Philippines
Landline


Mobile


Contact Number(s) in the Philippines
Landline


Mobile


Contact Number(s) in the Philippines
Landline


Mobile