ParadiseIslandForm.Version2021.

Samal TOURIST QR Code Application Form

Reminders:
1. QR code application will take at least 24 hours to be approved by the LGU of Samal;
2. All guests are required to have their respective QR Code per person;
3. QR code is for single use only;
4. NO QR codes will be issued for kids below 6 years old; and
5. Send us back the accomplished application form along with all your gov’t issued valid IDs w/ address.

Day Tour: Overnight: # of Room/s:

Reservation Date: from _________ to _________ Arrival Time: ____ ___
No. of Adults: _____3__ No. of Children (up to 12yrs old): ____________
Vehicle Plate #: _____ __ Entry Point: Private Terminal Public Ferry

EMAIL Address: _________________________________

(Samal City LGU will send to this email the QR codes once approved)

Guest # 1 / HEAD OF THE GROUP

Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 2
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 3
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 4
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City
*All guests must fill-up the application form.*
 ParadiseIslandForm.Version2021.4

Guest # 5
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 6
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 7
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 8
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 9
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 10
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

*All guests must fill-up the application form.*

 ParadiseIslandForm.Version2021.4

Guest # 11
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 12
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 13
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 14
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

Guest # 15
Complete Name: Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
St./Purok/Sitio Barangay District City

*All guests must fill-up the application form.*