Reminders in filling out the form:

1.Reproduction/ sharing/ posting of this form in any

forum/group pages/ Agency is NOT ALLOWED.

2.This form is intended for the client’s use. Please do not

ask other people or your partner to answer this form
for you.

3.Be truthful with your answers. All information asked

from you will be used in assessing your registration
and will be treated with utmost confidentiality.

4.Put N/A on items which are not applicable to you.

5.Return/ email back this form, with the necessary

information, to me at least one hour before your
webinar schedule to be accepted in the meeting room.

6. Use your complete name to be admitted in the

meeting room.
 GUIDANCE AND COUNSELING FORM

PERSONAL INFORMATION ABOUT YOU

FIRST MIDDLE LAST NAME
NAME NAME
BIRTHDATE (MONTH/DATE/YEAR) AGE
CIVIL STATUS BEFORE YOUR PRESENT
RELATIONSHIP (e.g. Single/ Lived-in-Unwed/ Married/
Annulled/ Divorce)

EDUCATIONAL ATTAINMENT (e.g. HS, Vocational, College

Graduate- state Course)
OCCUPATION (in the last six months)
Complete Philippine Address
CONTACT NUMBER EMAIL ADDRESS
PASSPORT NUMBER DATE OF ISSUANCE EXPIRATION
DATE
VISA CATEGORY (if DATE OF ISSUANCE EXPIRATION
applicable) DATE
Name of Nearest Relationship (e.g.
Relative in the Mother/ Father/
Philippines (in case of Aunt etc.)
emergency)
Complete Philippine Address
CONTACT NUMBER EMAIL ADDRESS
PETITIONER’S INFORMATION (Spouse/Fiancé/Partner)
FIRST MIDDLE LAST NAME
NAME NAME
BIRTHDATE (MONTH/DATE/YEAR) AGE
Place of Birth (State & CITIZENSHIP
Country)
CIVIL STATUS BEFORE YOUR PRESENT
RELATIONSHIP (e.g. Single/ Lived-in-Unwed/ Married/
Annulled/ Divorced)

Number of times Citizenship of ex- No. of Children

divorced (if applicable) partner/s from previous
relationship/s
EDUCATIONAL ATTAINMENT (e.g. HS, Vocational, College
Graduate- state Course)
OCCUPATION (in the last six months)
CONTACT NUMBER EMAIL ADDRESS

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Complete Home Address

PERSONAL INFORMATION OF CHILDREN

Do you have children from Name and Sex of your child/ren Date of Birth
present relationship? If yes,
how many?

Do you have children from Name and Sex of your Date of Birth Citizenship of the other
previous relationship? If child/ren parent
yes, how many?

ADDITIONAL INFORMATION

1. When and how did you meet your present

partner spouse/fiancé? Please specify (E.g. 2019-
Tinder)
2. Have you met him/her personally? If yes, where?
(Please specify the City and Country)
3. Your country of Destination and Purpose of travel
(ex. Thailand- to meet)
4. Do you have relative/s in your country of
destination? (If yes, write the name and your relationship)
5. Target date of travel

-END-

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