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BI FORM 2014-08-002A Rev 1 This document may be reproduced and is NOT FOR SALE

ANNUAL REPORT APPLICATION FORM


(FOR ALL TYPES OF VISA except E.O. 324/R.A. 7919)

Attach your 2x2 colored photograph Instructions:


with white background
1. Personally accomplish this form using black ink only.
using permanent glue in the
2. Check the corresponding box of your answer, if applicable.
photograph box.
3. LEAVE A BOX AFTER EACH NAME.
The photograph must be taken
4. Do not leave any item blank and write N/A if not applicable. Improperly/
within the last thirty (30) days from
incompletely filled out application form will not be acted upon.
the date of application.
A scanned photograph is not TYPE OF VISA
allowed. A photograph of the
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses, ACR /ACR I-CARD NUMBER
etc.) or headwear is not acceptable.

I. APPLICANT’S PERSONAL INFORMATION (as appearing on the passport)


Last Name

First/Given Name including Extension (Sr., Jr., III, IV)

Middle Name

Other Name(s)/Alias(es)

Date of Birth [DD-MMM-YYYYe.g. 01 JAN 1990] Age Gender

M F

Civil Status Country of Birth

Single Married Annulled

Citizenship/Nationality

Separated Widowed Divorced

Passport Number Date of Issuance [DD-MMM-YYYYe.g. 01 JAN 1990]

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

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

II. Spouse’s Information


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

Other Name(s)/Alias(es)

Date of Birth [DD-MMM-YYYYe.g. 01 JAN 1990] Age Gender

Male Female

Citizenship/Nationality Civil Status

Single Married Annulled

Passport Number

Separated Widowed Divorced

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

Type of Visa Immigrant Certificate of Residence [ICR] Number

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

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BI FORM 2014-08-002A Rev 1 This document may be reproduced and is NOT FOR SALE
ANNUAL REPORT APPLICATION FORM
(FOR ALL TYPES OF VISA except E.O. 324/R.A. 7919)
III. A. PETITIONER’S INFORMATION [for working/student visa holders]
Name of Petitioner [Company/School]

Registration Number/Company TIN

Registered Address of Petitioner Contact Number(s) in the Philippines


Room No., Floor No., Building, Street Landline

Barangay, Municipality/City Mobile

Province, Zip Code Position in the Company/Institution/School of Petitioner’s Representative

Name of Petitioner’s Representative [Company/School]

B. APPLICANT’S OTHER INFORMATION [for working visa holders]


Position/Proposed Position

Actual Monthly Gross Salary Alien Employment Permit [AEP] Number

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

IV. A. PETITIONER’S INFORMATION [for Immigrant/Temporary Resident Visa Holders]


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

Other Name(s) and Alias(es)

Residential Address in the Philippines


Citizenship/Nationality House/unit No., Street, Subdivision/Village

ACR I-Card Number Barangay, Municipality/City

Type of Visa Province, Zip Code

B. APPLICANT’S RELATIONSHIP TO THE PETITIONER

V. INFORMATION OF ALL LIVING CHILDREN [including those residing abroad]


1 Name of Child (as appearing on the passport, if applicable) [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es)

Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age

Passport Number Gender Civil Status

M F Single Married Annulled

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

Separated Widowed Divorced

Type of Visa Email Address

Spouse’s Name [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es) of Spouse

2 Name of Child (as appearing on the passport, if applicable) [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es)

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BI FORM 2014-08-002A Rev 1 This document may be reproduced and is NOT FOR SALE
ANNUAL REPORT APPLICATION FORM
(FOR ALL TYPES OF VISA except E.O. 324/R.A. 7919)
Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age

Passport Number Gender Civil Status

M F Single Married Annulled


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

Separated Widowed Divorced


Type of Visa Email Address

Spouse’s Name [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es) of Spouse

3 Name of Child (as appearing on the passport, if applicable) [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es)

Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age

Passport Number Gender Civil Status

M F Single Married Annulled

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

Separated Widowed Divorced

Type of Visa Email Address

Spouse’s Name [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es) of Spouse

4 Name of Child (as appearing on the passport, if applicable) [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es)

Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age

Passport Number Gender Civil Status

M F Single Married Annulled

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

Separated Widowed Divorced

Type of Visa Email Address

Spouse’s Name [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es) of Spouse

VI. PARENT’S INFORMATION


Name of Father (As appearing on the passport) [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es)

Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age

Page 3 of 4
BI FORM 2014-08-002A Rev 1 This document may be reproduced and is NOT FOR SALE
ANNUAL REPORT APPLICATION FORM
(FOR ALL TYPES OF VISA except E.O. 324/R.A. 7919)
Passport Number Civil Status

Single Married Annulled


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

Separated Widowed Divorced


Type of Visa ICR Number

ACR I-Card Number

Name of Mother (as appearing on the passport) [Last Name, First/Given Name, Middle Name]

Other Name(s)/Alias(es)

2
Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age

Passport Number Civil Status

Single Married Annulled


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

Separated Widowed Divorced


Type of Visa ICR Number

ACR I-Card Number

Specify the name(s) of deceased parent(s): [Last Name, First/Given Name, Middle Name]

2
Specify the name(s) of deceased child(ren): [Last Name, First/Given Name, Middle Name]

10

DO NOT FILLOUT THIS PORTION


- -
Date Received: _____________________________________
Received by: ________________________________________________ BI Office: _________________________________________
Signature over PRINTED NAME

CERTIFICATION
I certify under oath that all the information in the form is truthful, complete and correct. I understand that I will be held
liable under CA 613/RA 562/Revised Penal Code and my visa will be cancelled if any statement is false. In addition to the fo regoing,
I will be subject to deportation proceedings.

_______________________
Signature over Printed Name Date (DD-MMM-YYYY e.g. 01-JAN-1990)

Left Thumbprint Right Thumbprint


SUBSCRIBED AND SWORN TO before me this _____day of ___________________________________, 20_____ affiant exhibiting his/her ACR I-
Card no. and/or passport number _____________________________________ issued at ______________________________________ on
________________________.

Doc No. ________________


Book No. ________________ Notary Public/ Administering Officer
Page No. ________________
Series of ________________

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