FA Form 2-A______________
Photo 2" x 2"
APPLICATION FOR NON-IMMIGRANT VISA TO THE PHILIPPINES
________________________________________________20___
CLASSIFICATION______________________No._______________
Surname / Family Name / Last Name Citizenship
First Name / Given Name
Middle Name (mother's maiden surname / if married,
maiden surname)
Civil Status
Single
Widowed
Married
Divorced
Separated
Occupation Employer
Address of Employer
Date of Birth(mm/dd/yy)
Place of Birth
Current Address
in the US
(Apartment No.,
Street,City)
Sex
Male Female
State
Zip Code
Phone Number
Name of Spouse Address of Spouse
Reference in the
Philippines, if any.
Name, Address
Financial means of support and proof
Next Port of Destination
Business Pleasure
Purpose of Visit
Length and Dates of intended stay
Passport Country Issued By
Expiry Date (mm/dd/yy)
Passport Number
Issued on (mm/dd/yy)
Have you ever been
convicted of a crime?
If yes please provide
details
SUBSCRIBED AND SWORN to before me this _____ day of _______
OFFICER AUTHORIZED TO ADMINISTER OATH SIGNATURE OF APPLICANT
FOR OFFICIAL USE ONLY
The following people are
accompanying me to the
Philippines
Passport Visa No. ______________________ Granted___________________________ as non-immigrant under section
9( )_____________________________________. of the Philippine Immigration Act of 1940, as amended,
Multiple entry until________________________ Visa Includes:
CONSUL OF THE REPUBLIC OF THE PHILIPPINES
PRINT NAME AND SIGNATURE DATE RELEASED:
FOREIGN SERVICE OF THE PHILIPPINES
(Field for Embassy/Consulate General Address and contact nos.)
I solemnly swear that the foregoing statements are true to the best of my knowledge
and belief.
