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BI FORM 2014-08-002A Rev 1 This document may be reproduced and is NOT FOR SALE
ANNUAL REPORT APPLICATION FORM
(FOR ALL TYPES OF VISA except E.O. 324/R.A. 7919)
III. A. PETITIONER’S INFORMATION [for working/student visa holders]
Name of Petitioner [Company/School]
Expiration of Contract [DD-MMM-YYYY e.g. 01 JAN 1990] Expiry Date/Valid Until [DD-MMM-YYYY e.g. 01 JAN 1990]
Other Name(s)/Alias(es)
2 Name of Child (as appearing on the passport, if applicable) [Last Name, First/Given Name, Middle Name]
Other Name(s)/Alias(es)
Page 2 of 4
BI FORM 2014-08-002A Rev 1 This document may be reproduced and is NOT FOR SALE
ANNUAL REPORT APPLICATION FORM
(FOR ALL TYPES OF VISA except E.O. 324/R.A. 7919)
Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age
3 Name of Child (as appearing on the passport, if applicable) [Last Name, First/Given Name, Middle Name]
Other Name(s)/Alias(es)
4 Name of Child (as appearing on the passport, if applicable) [Last Name, First/Given Name, Middle Name]
Other Name(s)/Alias(es)
Other Name(s)/Alias(es)
Page 3 of 4
BI FORM 2014-08-002A Rev 1 This document may be reproduced and is NOT FOR SALE
ANNUAL REPORT APPLICATION FORM
(FOR ALL TYPES OF VISA except E.O. 324/R.A. 7919)
Passport Number Civil Status
Name of Mother (as appearing on the passport) [Last Name, First/Given Name, Middle Name]
Other Name(s)/Alias(es)
2
Citizenship/Nationality Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Age
Specify the name(s) of deceased parent(s): [Last Name, First/Given Name, Middle Name]
2
Specify the name(s) of deceased child(ren): [Last Name, First/Given Name, Middle Name]
10
CERTIFICATION
I certify under oath that all the information in the form is truthful, complete and correct. I understand that I will be held
liable under CA 613/RA 562/Revised Penal Code and my visa will be cancelled if any statement is false. In addition to the fo regoing,
I will be subject to deportation proceedings.
_______________________
Signature over Printed Name Date (DD-MMM-YYYY e.g. 01-JAN-1990)
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