01+017Revised Nov 2014/OCA-Visa

Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE

APPLICATION FOR CREW LIST VISA

A. DETAILS OF VESSEL TOTAL CREW

Vessel Name: including Master:
Official Number (IMO):
Flag State / Nationality:
Vessel Class/Type: FOREIGN CREW
Name of Owner:

B. DETAILS OF PREVIOUS VOYAGE

Please provide the necessary information pertaining to the most recent voyage prior to arrival in the Philippines. [ AFFIX VISA HERE ]
Country/Port of
Departure Date Country/Port of Arrival Arrival Date Name of Local Agent/Handler
Departure

C. VOYAGE/JOURNEY TO THE PHILIPPINES

Please provide the necessary information relative to the voyage of the vessel to the Philippines.
Country/Port of Port of Arrival in the Arrival Date
Departure Date Name of Local Agent/Handler
Departure Philippines (PHL)

G. NOTARIZATION

D. DETAILS OF SUCCEEDING VOYAGE

Please provide the necessary information relative to the next country and port of call from the Philippines.

Port of Departure in the Departure Date

Country/Port of Arrival Date of Arrival Name of Local Agent/Handler
Philippines (PHL)

E. ATTESTATION OF AGENT F. DECLARATION OF CAPTAIN/MASTER

I hereby certify and confirm that the all information supplied I solemnly declare that the information which I have provided
in this document and its attachments are true and correct. herein and in the attached crew list is true, accurate and complete
I further attest that the signature of the Captain/Master of to the best of my knowledge, and that I and my crew will abide by
the vessel appearing herein is genuine and authentic, and that I am the laws and regulations of the Republic of the Philippines for the
a duly authorized agent acting for and on behalf of the owners of the duration of our stay.
vessel.

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 01+017Revised Nov 2014/OCA-Visa

Signature Above Printed Name Signature Above Printed Name

(Local Agent) (Captain/Master of Vessel)

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 01+021
Revised Nov 2014/OCA-Visa

Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

10

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Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

10

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Page __ of __
Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

25

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Page __ of __
Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

49

50

Page __ of __
Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

10

11

12

13

14

15

16

17

18

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22

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24

Page __ of __
Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

25

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Page __ of __
Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

49

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Page __ of __
Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

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Page __ of __
Embassy of the Republic of the Philippines THIS FORM IS NOT FOR SALE
Vessel Name:
Official Number (IMO):
Flag/Nationality:
Date of Arrival:
(To be delivered to the Immigration Officer by the Commanding Officer of any vessel or aircaft upon arrival at a port in the Philippines) Port of Arrival:
H. LIST OF FOREIGN CREW MEMBERS

No. SURNAME GIVEN NAME (INCLUSIVE OF MIDDLENAME) DATE OF BIRTH PASSPORT / TRAVEL ISSUING COUNTRY BIRTHPLACE (IN TITLE / POSITION IN VESSEL REMARKS
DOCUMENT NUMBER PASSPORT)

97

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