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VISA APPLICATION FORM TO ENTER JAPAN

(Paste photo here)


45mm �45mm
or 2in�2in

*Official use only

(Surname (as shown in passport)) SOLIVEN


(Given and middle names (as shown in passport) ) April Paredes
(Other names (including any other names you are or have been known by)) NA
(Date of birth) 29/09/1993
(Place of birth) Vigan Ilocos Sur Philippines
(Day)/(Month)/(Year)

(City) (State or Province) (Country)

Male

(Male) Unchecked
Female

(Female ) Checked
Sex:

Marital status:

Single

(Single) Checked
Married

(Married ) Unchecked
Widowed

(Widowed ) Unchecked
Divorced

(Divorced) Unchecked
(Nationality or citizenship ) FILIPINO
(Former and/or other nationalities or citizenships) NA
(ID No. issued to you by your government) NA
Diplomatic

(Diplomatic) Unchecked
Official

(Official ) Unchecked
Ordinary

(Ordinary) Checked
Other

(Other) Unchecked
(Passport No. ) P2533463A
(Place of issue) City of San Fernando, La Union
(Date of issue) 06/06/2017
(Issuing authority ) DFA LA UNION
(Day)/(Month)/(Year)

(Date of expiry )
(Day)/(Month)/(Year)

(Purpose of visit to Japan ) Tour


(Intended length of stay in Japan) 8 Days
(Date of arrival in Japan) May 1 2019
(Port of entry into Japan ) Kansai Airport, Osaka
(Name of ship or airline) Cebu Pacific
Names and addresses of hotels or persons with whom applicant intends to stay

(Name) Art Hotel Osaka Bay Tower


(Tel. ) +81 6-6577-1111
(Address) 1 Chrome-2- 1 Benten, Minato Ward, Osaka, 5522-0007, Japan
(Dates and duration of previous stays in Japan) NA
Your current residential address (if you have more than one address, please list
them all)

(Address ) St. Therese Compound Sevilla, City of San Fernando, La Union


( Mobile No. ) 0917-779-2993
(Current profession or occupation and position) Respiratory Therapist III
Name and address of employer

(Name) Ilocos Training and Regional Medical Center


(Tel. ) (072) 607-6418
(Address) City of San Fernando, La Union
Passport type:

( Tel. ) NA
(*Partner's profession/occupation (or that of parents, if applicant is a minor):)
Entrepreneur
Guarantor or reference in Japan(Please provide details of the guarantor or the
person to be visited in Japan)

(Name ) NA
(Tel. ) NA
(Address ) NA
(Date of birth) NA
(Relationship to applicant ) NA
(Profession or occupation and position) NA
(Nationality and immigration status) NA
Inviter in Japan(Please write 'same as above' if the inviting person and the
guarantor are the same)

(Name ) NA
(Tel. ) NA
(Address ) NA
(Date of birth) NA
(Day)/(Month)/(Year)

* It is not mandatory to complete these items.

Any personal information gathered in this application as well as additional


information submitted for the visa application
(hereinafter referred to as "Retained Personal Information�) will be handled
appropriately in accordance with the Act on the
Protection of Personal Information Held by Administrative Organs (Act No. 58 of
2003, hereinafter, �the Act�). Retained Personal
Information will only be used for the purpose of processing the visa application
and to the extent necessary for the purposes
stated in Article 8 of the Act.

Male

(Male) Unchecked
Female

(Female ) Unchecked
Sex:

(Relationship to applicant ) NA
(Profession or occupation and position) NA
(Nationality and immigration status) NA
(*Remarks/Special circumstances, if any) NA
Have you ever:

. been convicted of a crime or offence in any country?

Yes

(Yes ) Unchecked
No

(No) Checked
. been sentenced to imprisonment for 1 year or more in any country?**

Yes

(Yes ) Unchecked
No

(No) Checked
. been deported or removed from Japan or any country for overstaying your visa or
violating
any law or regulation?

Yes

(Yes ) Unchecked
No

(No) Checked
. been convicted and sentenced for a drug offence in any country in violation of
law
concerning narcotics, marijuana, opium, stimulants or psychotropic substances?**

Yes

(Yes ) Unchecked
No

(No) Checked
. engaged in prostitution, or in the intermediation or solicitation of a prostitute
for other
persons, or in the provision of a place for prostitution, or any other activity
directly
connected to prostitution?

Yes

(Yes ) Unchecked
No

(No) Checked
. committed trafficking in persons or incited or aided another to commit such an
offence?

Yes

(Yes ) Unchecked
No

(No) Checked
** Please tick �Yes� if you have received any sentence, even if the sentence was
suspended.

If you answered �Yes� to any of the above questions, please provide relevant
details.

(T28) NA
�I hereby declare that the statement given above is true and correct. I understand
that immigration status and period of stay to
be granted are decided by the Japanese immigration authorities upon my arrival. I
understand that possession of a visa does not
entitle the bearer to enter Japan upon arrival at port of entry if he or she is
found inadmissible.�
�I hereby consent to the provision of my personal information (by an accredited
travel agent, within its capacity of representing
my visa application) to the Japanese embassy/consulate-general and (entrust the
agent with) the payment of my visa fee to the
Japanese embassy/consulate-general, when such payment is necessary.�

Signature of applicant

Sex:

Male

(Male) Unchecked
Female

(Female ) Unchecked
(Day)/(Month)/(Year)

(Day)/(Month)/(Year)

(Date of application) 01/04/2019