REPUBLIC OF THE PHILIPPINESFOREIGN SERVICE OF THE PHILIPPINES

Embassy of the PhilippinesNairobi, Kenya

APPLICATION FOR NON-IMMIGRANT VISA (9-A)FILL-IN BLANKS (TO BE ACCOMPLISHED IN ENGLISH) TYPE WRITTEN IN BLOCK LETTERS

Surname: First Name:

Place of Birth: (City / Country) Date of Birth: (Month/Date/Year) Age: Citizenship: Sex: Male Female

Applicant's Address: (Flat no. / Villa no.: Building Name/No.: Street: District/Area: County ) Contact No.: (Mobile No/ Telephone no.)

Occupation: Office of Employment and Address: Contact No.: (Mobile No/ Telephone no.)

Father's Name: Mother's Name:

Civil Status: Single Married

Widowed Separated Divorced/Annulled:

If married, name of spouse: Citizenship:

Name/s and age/s of Child/ , if any:

Name and address of sponsor/reference in the Philippines: Contact No.: (Mobile No/ Telephone no.)

Passport/Travel Document no: Date of Issue: Valid until: Issued by:

Flight Details: (Entry)

Date :______________

Flight No. :______________

Port of Entry :______________

Flight Details: (Exit)

Date :_______________

Flight No. :_______________

Port of Exit :_______________

Length of stay: Purpose of Entry: Tourism

Business Others, Pls. Specify ________

________________________Name of travelling companion (for minor applicant): Destination after the Philippines:

Have you ever been issued a Philippine visa? Yes No , If yes, please attach copy of latest visa.Latest visa no. ____________________ Type of Visa: __________________ Issued on: ______________________ Issued by: ________________________

NOTE: *Additional requirements may be required.1. Were you ever refused any kind of Philippine visa before and denied admission into or deported from the Philippines? Yes No If yes, state circumstances ___________________________________________________________________________2. Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other legal action? Yes No If yes, state circumstances ___________________________________________________________________________3. Have you ever been afflicted with a communicable disease of public health significance, dangerous physical or mental disorder, or been a drug abuser or addict? Yes No

I understand that I may only enter the Philippines at the Port of Entry designated by the Philippine Immigration Authorities and under the conditionimposed by those of authorities.

I solemnly swear that the foregoing statements are true to the best of my knowledge.Warning: ( 1 ) Drug trafficking is punishable under Philippine law. ( 2 ) Tourists are not allowed to engage in any peddling activity. Violators will be subject for deportation

Non-immigrant visa no. ______________________________ under section _________________________________ of the Philippine Immigration Act of 1940,

as amended, issued on ________________________________ and valid until _________________________________.

SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF _________________________________________________.

OR No. _______________

Service No. ____________

Fee. __________________

Remarks if any:

Attach recentpassport-sized colored photo

(taken within the last 6 months )

Applicant's Printed Name & Signature

CMISDhonsky

size 4.5 cm x 3.5 cm

DO NOT WRITE BELOW THIS LINE, FOR THE DEPARTMENT'S USE ONLY.