—~Visas~Camigranit) FA Form No. 3 (Revised 1961) FOREIGN SERVICE OF THE PHILIPPINES PHILIPPINES(POST) EMBASSY, SEQUL,KOREA. (applicant's APPLICATION FOR IMMIGRANT VISA QUOTA/NON-QUOTA Signed Photograph) Surname First Name Middle Name | Sex Tate of Biren O Male Female [facet brho Civil Status Widowed vf married state name and address of Single Separaced aici Married Divorced Applicant's Address(es) for the past 5 years Since Occupation Since Father's Name Mother's Name Place Where Applicant intend to settle Occupation to be pursued Name and Address of employer, if any Nearest relatives in the Philippines Name Address Relationship INSTRUCTIONS: This form should be filed out in duplicate, che original to be given to the applicant and the duplicate copy th be filed at the consulate. Have you ever been institutionalized for any mental disorder? No Yes (stare nature) Do you have a physical defect? 7 Ko. D Yes (seate nacure) Have you ever been convicted of any cx No DiYes (State when, where and nature) Are you afflicted with aay contagious disease? Xe : Des (state nacure). On what basis do you claim co be a Preference Quota Immigranc GNon-Quota Immigranc? Seate faces on which you base ypur claim Have you ever been refused a visa of any kind at a Philippine diplomatic er consular, office, or been denied admission inca che Philippines, or been deported or removed at government expense from the Philippines? DN Cy ves (state circumscances) I understand that I may only encer the Philippines at a port of entry | destgnaced by the Philippine Immigration authorities and with the permission’ of ané under the conditions, including the giving of bond, imposed by those authorities. I solemnly swear that the foregoing statements are true to the best of my| knowledge and belief. (Signature of Applicant) Subscribed and sworn co before me this day of . 19 E (sean) Consul of che Republic of che Philippines Service No. 0.8. No. Philippine Immigranc Visa No. Quota Immigrant Non-Quota Immigrant under Quota No Section of che Philip- SE eee eed pine Immigration Act of 1940, | ts amended, sued co Jace Nadionaliey |" Vatia wrest Bearer has che following travel document? ‘Type. No. Dace of Issue Issued by Valid uneil Corfsul of the Republic of che 0.R.No Philippines