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Emigration Clearance Certificate (Ecc) Application Form

This document is an application form for an Emigration Clearance Certificate (ECC) from the Bureau of Immigration in the Philippines. The form collects information such as name, date of birth, citizenship, passport details, and contact information. It explains the different types of ECCs available, including for Philippine citizens, student visa holders, and tourist visa holders staying over six months. Applicants must provide a recent photograph and swear that the information is true before signing and providing fingerprints. The bottom portion is a claim stub to be filled out by immigration officials after filing to provide tracking details.

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Jec Gagua
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1K views

Emigration Clearance Certificate (Ecc) Application Form

This document is an application form for an Emigration Clearance Certificate (ECC) from the Bureau of Immigration in the Philippines. The form collects information such as name, date of birth, citizenship, passport details, and contact information. It explains the different types of ECCs available, including for Philippine citizens, student visa holders, and tourist visa holders staying over six months. Applicants must provide a recent photograph and swear that the information is true before signing and providing fingerprints. The bottom portion is a claim stub to be filled out by immigration officials after filing to provide tracking details.

Uploaded by

Jec Gagua
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BI FORM 2014-08-004 Rev 0 This document may be reproduced and is NOT FOR SALE

EMIGRATION CLEARANCE CERTIFICATE (ECC) APPLICATION FORM


I. APPLICATION INFORMATION
Attach your 2x2 colored photograph II.ECC-A
with white background
Philippine Born Philippine Born-US Passport Holder Student Visa
using permanent glue in the
photograph box. Lost ACR I-Card Tourist (with More than Six Months of Downgraded Visa
Stay in the Philippines)
The photograph must be taken
within the last three (3) months ECC-B
from the date of application.
Re-Entry Permit (RP) Special Return Certificate (SRC)
A scanned photograph is not
allowed. A photograph of the Certificate Of Exemption (CE)
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses, II. METHOD OF APPLICATION
etc.) or headwear is not acceptable.
Personal Authorized Representative

III. APPLICANT’S 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 Citizenship/Nationality
M F
Marital Status Country of Birth
Single Annulled Widowed

Married Separated Divorced


Residential Address in the Philippines Contact Number(s) in the Philippines
House/Unit No., Street, Subdivision Landline

Barangay, Municipality/City Mobile

Province, Zip Code Email Address

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

IV. APPLICANT’S TRAVEL INFORMATION


Passport Number Place of Issuance

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

V. Alien Certificate of Registration Identity Card (ACR I-Card)


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

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

I hereby swear/affirm that all information provided is


true and correct to the best of my knowledge and belief;
that I voluntarily submitted authenticated/ original DO NOT FILL OUT THIS PORTION
documents to verify my application, and that there exists
no pending criminal civil or administrative action which
requires my presence.
Received by: __________________________________

___________ _________________________________ Recommended by: ______________________________


Date Applicant’s Signature over Printed Name
Left Right
Reviewed by: __________________________________
Thumbprint Thumbprint
Approved by: __________________________________
Verified by: ________________________________
Fingerprint Examiner
(Signature over Printed Name)

[To be filled out by Authorized BI Personnel Only]

ECC-A/CE/ECC-B/SRC/RP CLAIM STUB


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

_____________________
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Date & Time FILED

Citizenship/Nationality
_____________________
 ECC Reference Number shall be sent through e-mail, if e-mail address is provided. Date & Time RELEASED
 Always present this claim stub upon claiming your certificate.
 Unclaimed certificate shall be automatically cancelled after 30 days from the date of issuance. ___________________________
 If claimed by an authorized representative, present a Special Power of Attorney (SPA) and original BI Receiving Personnel
valid government-issued ID.

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