BI FORM CGAF-001-Rev 2 ‘This document may be reproduced and is NOT FOR SALE CONSOLIDATED GENERAL APPLICATION FORM FOR IMMIGRANT VISA 1, APPLICATION INFORMATION Present immigration State Nature oFAppicaton [J conversion [7] amenament [7] tnetusion Peet pleat tod oF pplicaion Personal ‘Authonzed Representative Torr eaiat ra ame of Aathoraed Representative (LastName, Fra¥Given Name, ale Name] 1. APPLICANT'S TRAVEL INFORMATION ayaa of Br [OO-WNBI-YWWea. Oi JAN 1960] Gander Country Fh singe Mame porated eight fam weight Oa) ‘separaea Wome Divorced Cl “Taxpayer entiation Number (IN) ‘Gontact Number(s) i Lorene mal adress ote ‘eosidenti actress Inthe Philippines Residential Address Abroad END, S98 ga oussAMihe,, eect Sedvieen/ tage 999, MURSPSR TORY = \dcle Name (Heese leave 8 box after 20%) name) so Type Page 1 of 2BI FORM CGAF-001-Rev 2 ‘This document may be reproduced and is NOT FOR SALE CONSOLIDATED GENERAL APPLICATION FORM FOR IMMIGRANT VISA [UFTHE ACR E-CARD IS CLAIMED BY AN AUTHORIZED REPRESENTATIVE, PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS. ] Character References in the Philipines et tame, Fst/eiven Name, Md hare (dental Address Hovse/Unit ho 5 nip City nee, Zp Code ‘Contact Number(2) inthe Laine Nobile ame, st [Sive ame, Nil {dental Address in the Philippines ise/ UNE No, Steet, Subdision Mage, renga, Nuiipay/Ciy Prowe, Zp Code ‘Wurnber(s) nthe Philip Lanaine Mobile (dental Address Novee/Uni hoy 5 Sarangay, Munipalty/Cy Prone, Zp Cade ‘Contact Number(s) inthe Philip Laine V.ACR I-card Ilan Coraiesta of Registration (ACR) Number Do NoT ‘Application numb Date of Iunnes [OO:HHN-Wrrveg. OFAN 1980] i Eipicy Dete[Vald Uri |o0-WN-Y¥¥eq. 08 2AN £990) Recelved/Recommended by: LI Reviewed by: si amps: (SW. approved by’ CERTIFICATION IMe certify that: (1) All the information in the application is truthful, complete and correct; (2) All documents are authentic and were legally obtained from the corresponding govemment agencies or private entities; (3) /We Understand that my/our application may be summarily denied if: (a) Any statement is false; (b) Any document submitted is falsified; or (c) 1/We fail to comply with all the BI requirements without prejudice to whatever action the BI may take; and (4) I/We have not filed this or any similar application before any office of the Bureau, Date [DD-MiMM-vwwy Petitioner's Signature over Printed Name ‘Applicant's Signature over Printed Name ‘2.9. 01 JAN 1990] "ACR ICCARD WILL ONLY BE RELEASED UPON COMPLIANCE/ SUBMISSION OF THE FF: 4 Photocopy of passport blo-page ofthe ACR I-Card hkder 2. Vals 10 of eehor paren claiming tho ACR Icar applicant a minor ‘S.photocopy ofthe Br Accreditation ID car, ciamad bya aval agente a rm 4 Speci! Power of Atiorrey (SPA), If cmed by on autorized representative cther than the Parent or Bt acre ent Name of Represaratve ‘Accraited Travel Agany/Law Oca 11 Accreditation Ho, Contact No, Residential Often Address ROR Cand gers tat: Signatur, ‘Sgatire over ‘Signatre [Pane cal (+622) 525-7557 to check the status of your applcaton Page 2 of 2