ADDITIONAL INFORMATION FOR THE CLIENT

Given Name: Divina

Middle Name: Pacsilo
Surname: Garcia
Marital Status: Single
Birth date: July 21, 1992
Place and City of Birth: Abat Tinoc Ifugao, Philippines
State/Province: Ifugao
Nationality: Filipino
Do you hold or have held any nationality other than the one indicated in your Nationality: No
Are you a permanent resident of a country/region other than your country/region of origin? No

National Identification Number:

U.S Social Security Number: N/a
U.S Taxpayer ID Number:N/a

Philippines Address: Fe 078 Km 4 La Trinidad, Benguet

City: La Trinidad
State/Province: Benguet
Zip Code/Postal Zone: 2600
Is your mailing address the same as your Home Address? Yes
Home Phone Number:N/a
Work Phone Number:n/a
Work Fax Number:n/a
Mobile Number: +65 81219863
Email Address: divinapgarcia92@gmail.com
Gender: Female

SOCIAL MEDIA

Social Media Provider/Platform: divigarx

Social Media Identifier: instagram

PASSPORT INFORMATION

Passport Document Type:

Passport Number: P2798519B
Passport Book Number: P2798519B
City where issued: Singapore
Country/Region where issued: Singapore
Passport issued date: 16 Aug 2019
Passport expiration date: 15 Aug 2019

Have you ever lost a passport or stolen? No

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Do you hold or have you held any nationality other than the one indicated above on nationality? No
Have you ever used other names? (i.e., maiden, religious, professional, alias, etc.?) No

Where did you know about the Agency (Isearch International Co.)?
Marketing platform- facebook

TRAVEL INFORMATION

Person/Entity paying for your trip: Personal Expense

Name of the person paying for your trip: Divina Garcia
Telephone Number:
Mobile Number: +65 81219863
Email address: (if any please provide)divinapgarcia92@gmail.com
Relationship to you:
Is the address of the person paying for your trip the same as your home address? Yes
If NO please provide:
Address:
City:
Province:
Zip Code/Postal Zone:
Other persons travelling with you:

Have you ever been to US?No

(if “YES” please provide information on your last five U.S. visits)
Date of Arrival: (Format: DD/MM/YYYY)
Length of Stay:
Start Date:
End Date:
Name of Program Sponsor:
Program Name:
Do you or did you ever hold a U.S. driver’s license?
Driver’s License Number:
State (where in U.S.) of Driver’s License:

Have you ever been issued a U.S. Visa? No

What Type of Visa?
Date last visa was issued (Format: DD/MM/YYYY):
Visa Number:
Are you applying for the same type of VISA?
Are you applying in the same country where the VISA above is issued and is this country your
principal country of residence? no

Have you been ten-printed? (Ten-printed means that you have provided fingerprints for all your
fingers, as opposed to having provided only two fingerprints) no
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Has your U.S. Visa been lost or stolen?
Has your U.S. Visa been cancelled or revoked?

Have you ever been refused a U.S. visa, been refused admission to the United States, or withdrawn
your application for admission at the point of entry? If YES please specify and why. No

Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and
Immigration Services? No

FAMILY INFORMATION

Father’s Surname: Garcia

Father’s Given Name: Andres
Father’s Date of Birth: April 4, 1950
Mobile Number: +639277441374
Is your Father in the U.S.? No
Mother’s Surname (Maiden Name): Pacsilo
Mother’s Given Name: Elena
Mother’s Date of Birth: April 8, 1953
Mobile Number: +639275173414
Is your Mother in the U.S.? No

Do you have any immediate relatives, not including parents in the US? (If YES please provide the ff:
Full Name: No
Relationship to you:N/a
Relative’s Status in the U.S.:N/a
Immediate relatives means Fiancé/Fiancéé, Spouse (husband/wife), Child (son/daughter), or sibling
(brother/sister).

Do you have any other relatives in the U.S.? N/A

Name: N/a
Relative’s Status in the US: N/a

WORK INFORMATION

Primary Occupation: F&B Supervisor

Company: Harry’s International Pte Ltd
Address: 28 Boat Quay, Singapore
City: Singapore
State/Province: Singapore
Zip Code: 0498818
Mobile Number:
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Landline:+65 68380461
Job Title: Senior Supervisor
Supervisor Name: Sumit Kumar
Start date: January 7 2016
End date: present
Monthly income in local currency (if employed): SGD 2500
Implementing Shop policies and procedures including
Duties typically include interviewing, hiring, training, scheduling and managing
employees, as well as overseeing inventory, including food and beverages,
supplies and other restaurant equipment of Harry’s.

Were you previously employed?

If not employed please explain why: (put Student for interns)
If employed please provide the name of your recent employer:
Employer Name:
Company:
Address:
City:
State/Province:
Zip Code:
Mobile Number:
Landline:
Job Title:
Supervisor Name:
Start date:
End date:
Monthly income in local currency (if employed):
Job duties:

Have you attended any educational institutions at a secondary level or above? Yes
Do you belong to a clan or tribe? Yes

Provide a List of Languages you speak: English, Filipino

Have you traveled to any country within the last five years? Yes
If yes, provide a list if countries visited: Japan, Australia, Thailand, Malaysia, Vietnam, Indonesia,
Singapore

Have you belonged to, contributed to, or worked for any professional, social or charitable
organization? If yes please provide. Wildlife friends Foundation
Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or
chemical experience? If yes, please provide. No
Have you ever served in the military? If yes, please provide.No

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Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit,
rebel group, guerrilla group, or insurgent organization? If yes, please provide. No

SCHOOL INFORMATION

Name of School: University of the Cordilleras

Address: Governor Pack Rd, Baguio Philippines
City: Baguio City
Province: Benguet
Zip Code: 2601
Course of Study: Bachelor of Science in Hospitality Mangement
Date of Attendance From: June 2, 2008
Date of Attendance To: May 24, 2011
Do you belong to a clan or tribe? yes
Provide list of languages you speak: English and Filipino
Have you travelled to any countries within the last five years? Yes

Provide a List of Companies Visited: (OJT can be included but not necessary)

SECURITY AND BACKGROUND QUESTIONS:

Answer Yes or No only.

1. Do you have a communicable disease of public health significance? (Communicable disease

of public significance include Chancroid, Gonorrhea, Granuloma Inguinale, Infectious Leprosy,
Lymphogranuloma Venereum, Infectious Stage Syphilis, Active tuberculosis, and other disease
as determined by the Department of Helath and Human Services.No

2. Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety
or welfare of yourself or others? No

3. Are you or have you ever been a drug abuser or addict? No

4. Have you ever been arrested or convicted for any offense or crime, even though subject of a
pardon, amnesty, or other similar action? No

5. Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled
substances? No

6. Are you coming to US t engaged in prostitution or lawful commercialized vice or have been
engaged in prostitution or procuring prostitutes within the past 10 years?No

7. Have you even been involved in, or do you seek to engaged in, money laundering? No

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8. Have you ever committed or conspired to commit a human trafficking offense in the US or
outside the US? No

9. Have you ever knowingly aided, abetted, assisted or colluded with an individual who has
committed, or conspired to commit a severe human trafficking offense in the US or outside the
US? No

10. Are you a spouse, son, or daughter of an individual who has committed or conspired to commit
a human trafficking offense in the US or outside the US and have within the last five years,
knowingly benefited from the trafficking activities? No

11. Do you seek or engaged in espionage, sabotage, export control violations, or any other illegal
activity while in the US? No

12. Do you seek to engaged in terrorist activities while in the US or have you ever engaged in
terrorist activities? No

13. Have you ever or do you intend to provide financial assistance or other support to terrorist or
terrorist organizations? No

14. Are you a member or representative of a terrorist organization? No

15. Have you ever ordered, incited committed, assisted, or otherwise participated in genocide? No

16. Have you ever committed, orders, incited, assisted, or otherwise participated in torture? No

17. Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial
killings, political killings, or other acts of violence? No

18. Have you ever engaged in the recruitment or the use of child soldiers? No

19. Have you, while serving as a government official, been responsible for or directly carried out,
at any time, particularly severe violations of religious freedom? No

20. Have you ever been directly involved in the establishment or enforcement of population control
forcing a woman to undergo an abortion against her free choice or a man or woman to
undergo sterilization against his or her free will?No

21. Have you ever been directly involved in the coercive transplantation of human organs or bodily
tissue? No

22. Have you ever sought to obtain or assist other to obtain a visa, entry into the US, or any other
US immigration benefit by fraud or willful misrepresentation or other unlawful means? No

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 23. Have you ever withheld custody of a US citizen child outside the US from a person granted
legal custody by a US Court? No

24. Have you voted in the US in violation of any law or regulation? No

25. Have you ever renounced US citizenship for the purposes of avoiding taxation? No

26. Have you ever used other names (i.e., maiden, religious, professional, alias, etc,)? No

27. Do you have a telecode that represents your name? No

ADDITIONAL POINT OF CONTACT INFORMATION/REFERENCES

NOTE: You have indicated that you will be studying in some capacity while in the United Sates. List at
least two contacts in your country of residence who can verify the information that you have provided
on this application. Do not list immediate family members or other relatives. Postal office box
numbers are unacceptable.

Need at least two:

Name: Irene Moslares

Address: 28 Boat Quay Singapore
City: Singapore
Province:
Zip Code:
Country: Singapore
Landline:
Mobile Number: +6590171887
Email Address: ren@harrys.com.sg

Name: Damien Fourret

Address: Orchard Road, Singapore
City:
Province:
Zip Code:
Country: Singapore
Landline:
Mobile Number:+65 98576903
Email Address:damienfourret@grandewhisky.com

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