BI FORM This document may be reproduced and is NOT FOR SALE

BI ACCREDITATION APPLICATION FORM

FOR LIAISON OFFICERS AND REPRESENTATIVES

Attach your 2x2 colored photograph
with white background using
permanent glue in the
photograph box.
The photograph must be taken
within the last three (3) months
from the date of application.
A scanned photograph is not
allowed. A photograph of the
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses,
etc.) or headwear is not acceptable.
REMINDERS:
1. Accomplish this form by writing as legibly & comprehensively as possible.
2. Check the corresponding box of your answer, if applicable.
3. Submit 2 pieces of 2x2 colored photograph. Paste one photograph on the
corresponding space and submit the other one to the concerned frontline officer.
4. Please comply with the requirements to avoid delay in issuing your
accreditation.
5. Any changes in the provided information without informing the Bureau will be
ground for denial or cancellation of the accreditation.
(INFORMATION PROVIDED WILL BE THE BASIS FOR ID PRINTING.)

APPLICATION CATEGORY
Law Office Consultancy Office/Corporation Consular Office or Government Organization

Travel Agency Missionary Other Entity

BONDS
Cash Bond O.R. No.

Surety Bond O.R No.

N/A

I. APPLICATION
Nature of Application
New Applicant Renewal

II. APPLICANT’S PERSONAL INFORMATION

Last Name

First/Given Name

Middle Name

Other Name(s)/Alias(es)
1

2
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Gender Civil Status
M F Single Married Annulled

Height [cm] Weight [kg] Widowed

Separated Divorced
Citizenship/Nationality

Social Security System (SSS) Number PhilHealth Number

Government Service Insurance System (GSIS) Number Tax Identification Number (TIN)

Company/ Agency Employee Number

Residential Address in the Philippines Contact Number(s) in the Philippines

House/Unit No., Street, Subdivision/Village Landline

Barangay, Municipality/City Mobile

Province, Zip Code Email Address

III. EMPLOYMENT
Name of Office

Designation

Office Address Contact Number(s) in the Philippines

Room No., Floor No., Building, Street Landline

Barangay, Municipality/City Mobile

Province, Zip Code Facsimile

Email Address

Form COM11.QF.006 Effective 01 April 2022

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 BI FORM This document may be reproduced and is NOT FOR SALE
BI ACCREDITATION APPLICATION FORM
FOR LIAISON OFFICERS AND REPRESENTATIVES
Immigration-related Seminars Attended
1. Title of Seminar

Batch No. Date of Seminar [DD-MMM-YYYY e.g. 01 JAN 1990]

2. Title of Seminar

Batch No. Date of Seminar [DD-MMM-YYYY e.g. 01 JAN 1990]

3. Title of Seminar

Batch No. Date of Seminar [DD-MMM-YYYY e.g. 01 JAN 1990]

IV. EMPLOYMENT HISTORY

1. Organization

Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000]

-
2. Organization

Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000]

-
3. Organization

Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000]

-
4. Organization

Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000]

-
V. Have you ever been issued a Ban Order/Cancellation Order in violation of BI Accreditation guidelines or regulations?
YES NO

If YES, give details: _ _ _ _ _ _ _ _ _

[Violation] [Date of Order] [Ban/Cancellation Order Number]

Was your Ban Order lifted? Give details: _ ___ _ _ _ _ _ _

[Date of Order] [Lifting Ban Order Number]

I declare that this BI Accreditation Application Form has been accomplished by me, and is true, correct and
complete pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.

I also authorize the agency head/authorized representative to verify/validate the contents stated herein. I trust
that information shall remain confidential.

Date [DD-MMM-YYYY e.g. 01 JAN 1990] Applicant’s Signature over Printed Name

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