LAG.2.F.
004
Rev. 01: 02 May 2022
Republic of the Philippines
PHILIPPINE ECONOMIC ZONE AUTHORITY
DoubleDragon Center West Building
DD Meridian Park, Macapagal Avenue, Pasay City
Trunk Line No.: (632) 8551-3451 Loc. 111/112/117 | Direct Line No.: (632) 8551-3427 | E-mail Add:
fnu@peza.gov.ph
APPLICATION FOR PEZA VISA (PV)
The undersigned hereby requests for issuance of a PEZA Visa (PV) with special multiple entry
privileges and with exemptions from exit clearances certificates, re-entry permits and special
return certificates, pursuant to Memorandum of Agreement between Philippine Economic Zone
Authority (PEZA) and Bureau of Immigration (BI), and in support thereof submits the following
information and representation.
FRED JACK KUMETZ
FIRST NAME MIDDLE NAME LAST NAME
73
Age: _________ MALE
Sex: _________ OCT. 3, 1948
Date of Birth: ___________ MEXICO CITY
Place of Birth: ______________
MEXICAN
Nationality _______________ MARRIED
Civil Status (Single, Married, Divorced, etc.): _____________
N00245400
Passport No. ________________________ LOS ANGELES
Issued at: ______________________________
Issued on: DEC. 16, 2021
________________________ DEC. 16, 2031
Valid until: _____________________________
c/o UNIT 3401 FORBES TOWER CONDOMINIUM, VALERO ST.,
SALCEDO VILLAGE, MAKATI CITY
Philippine Residential Address:____________________________________________________
0917-8268888
Telephone: ______________
eDATA SERVICES PHILS., INC.
Employing PEZA-registered enterprise: _____________________________________________
11/F UNIT A, TEN WEST CAMPUS BLDG., 20 LE GRAND AVE., MCKINLEY WEST, FORT BONIFACIO, TAGUIG CITY
Enterprise Address: _____________________________________________________________
PRESIDENT
Position: ______________________ 8884-1567/1568
Tel No.: __________ fkumetz@kumetz.com
E-mail Address: _______________
Date of Arrival and Length of Stay (for new application): _________________________________
JURIS DOCTOR DEGREE,SOUTHWESTERN
Educational Background, Training and Experience: ____________________________________
UNIVERSITY SCHOOL OF LAW L.A., CALIFORNIA; ADJUNCT PROFESSOR OF LAW;
_____________________________________________________________________________
ATTORNEY FOR THE MEXICAN CONSULATE IN L.A. CALIFORNIA
_____________________________________________________________________________
DEPENDENTS APPLYING FOR VISA WITH THE PRINCIPAL IN THE PHILIPPINES:
Spouse: Name: ____________________________ Age: ____ Sex: ___ Date of Birth: __________
Passport No: _______________ Nationality: ____________
Children: Name: ____________________________ Age: ____ Sex: ___ Date of Birth: _________
Passport No: _______________ Nationality: ____________
Name: ____________________________ Age: ____ Sex: ___ Date of Birth: _________
Passport No: _______________ Nationality: ____________
UNDERTAKING OF PEZA REGISTERED ENTERPRISE:
a) Within five (5) working days from termination or cessation of employment for whatever cause,
the PEZA-registered enterprise shall inform PEZA in writing of such termination or cessation of
employment and when applicable, within the same period, shall surrender the work permit and/or
ACR I-Card.
b) PEZA-registered enterprise shall likewise assume responsibility for the voluntary departure
and cancellation of PEZA visa of said Foreign National upon termination of employment/training.
DOCUMENTARY REQUIREMENTS:
PEZA ZA/ZM Endorsement to the Director General
Copy of PEZA Official Receipt issued for payment of the Processing Fee duly certified as true
copy by the PEZA Cashier or the assigned Special Collecting Officer of PEZA in the ecozone,
or print out of the successful confirmation of the Processing Fee payment through the
Electronic Payment and Collection System, and indicating therein the name of the foreign
national and his/her qualified dependents, if applicable
Checklist of application for PV Extension or for Change of Admission.
Photocopy of PEZA Certificate of Registration.
Photocopy of passport of the foreign national (Bio page, Pages containing date of latest arrival
and the valid/expiring/updated visa) with validity of not less than six (6) months from time of
application.
Notarized Certificate of Employment or Contract of Employment, indicating the period of
employment.
Notarized Certification signed by the President or Chief Executive Officer or duly authorized
official stating (1) the number of foreign nationals employed vis-à-vis Filipino employees; and
(2) the current percentage of employed foreign nationals over the total work force.
Certified True Copy of the foreign national’s Alien Employment Permit (AEP), or Certificate of
Exclusion issued by DOLE.
Comprehensive Bio-data/Resume/Curriculum Vitae duly signed by the applicant.
Understudy with Undertaking for technical and supervisory positions.
Organizational chart of the enterprise.
Birth certificate (children)/marriage certificate (spouse) with English translation and Philippine
embassy/consulate authentication from Applicant’s country of origin OR with Apostille OR
PSA-issued marriage/birth certificate.
Notarized Affidavit of Support/Guarantee, executed by the PEZA-registered company’s
President/Vice-President.
Done in the City/Province of _________________Philippines, this ___________ Day of
______________, 2022.
_______________
(Signature)
REPUBLIC OF THE PHILIPPINES)
CITY/PROVINCE OF __________) S.S.
SUBSCRIBED AND SWORN to me before me this ___________ day of ____________,
2022, in the City/Province of ____________, affiant exhibited to me his/her ACR or Passport No.
_____________
N00245400 issued at _______________
LOS ANGELES on _____________________.
DECEMBER 16, 2021
____________________
NOTARY PUBLIC
Until December 31, 2022
Doc. No. __________;
Page No.__________;
Book No.__________;
Series of 2022______;
