INTERNATIONAL PREMIER TENNIS LEAGUE

INFORMATION FORM
o Player
o Player's Guest

Category

Personal Details - Required

o
Mr

Title

IPTL Staff Member

o
o IPTL Production Crew

o Franchise Owner / Guest

o Other

o Miss

o Mrs

*Please fill-up in BLOCK letters as per Passport Details

*Last Name

*First Name

PARPAN

KYLE BENJAMINE

BAGASAN

Profession/Occupation

*Current Nationality

Previous Nationality

STUDENT

FILIPINO

* Date of Birth
DD

MM

01

YYYY)

04

1996

*Middle Name

*Place of Birth

*Country of Birth

SAN JUAN CITY

PHILIPPINES

Single
o

Marital Status

o Married

Father's Name

Mother's Name

JOSE JECKRY T. PARPAN

MA. THERESA B. PARPAN

o Widowed

Contact Details - Required

Mobile/Cell Phone No.

Country Code

Area Code

+63

No.

9154330054

No.

2775044

Telephone/Landline No.

Country Code

Area Code

+63

02

Email Address

KYLE_PARPAN@YAHOO.COM
Residential Address (Bldg./Apartment/House Name & No., Street Name & No., Area, etc.)

Town/City

833 PUSO ST. COLOONG 1

VALENZUELA CITY

State/Province/County/Emirate

Country

Zip Code

NCR

PHILIPPINES

1444

Mailing Address, PO Box, etc. (if different from Residential Address)

Town/City

833 PUSO ST. COLOONG 1

VALENZUELA CITY

State/Province/County/Emirate

Country

Zip Code

NCR

PHILIPPINES

1444

Passport Details - Required

Type of Passport

o
Normal
o Private

o Travel document
o Diplomatic

Date of Issue (DD-MM-YYYY)

Date of Expiry (DD-MM-YYYY)

31-03-2010

31-03-2015

Passport No.

Place of Issue

Country of Issue

WW0544312

MANILA

PHILIPPINES

Important: Passport MUST be valid for more than 6-months from 12 December 2014.

Emergency Information - Fill in all blanks - Required

Name of Contact Person In Case of Emergency

Relation to Participant

JOSE JECKRY T. PARPAN

PARENT (FATHER)

Emergency Contact No.

Country Code

Area Code

+63

No.

9175208129

Allergies to medication or other (please list) :

Any medications taken regularly (please list) :
Any medical concerns that should be noted:

Travel Details

Airport of Origin traveling to the IPTL

Airport of Destination traveling from the IPTL

Applicant must provide: 1x color passport copy (max 150 kb) and 1x color passport picture with white background (max 150kb)
DISCLAIMER: 1. IPTL warrants that all information provided is treated strictly confidential & will only be used by authorized IPTL officials in relation to
travel arrangements and dealing with emergencies.
2. IPTL can not be held responsible if information provided in this form is incorrect and if it affects any travel or visa applications through IPTL.

Contact:

Abhishek Ponia - General Manager

abhishek@premiertennisleague.com