special resident retiree's visa application - Philippine Retirement ...

SPECIAL RESIDENT RETIREE'S VISA APPLICATION
(Form PRA-RSC-2007-001)
Republic of the Philippines
BOARD OF INVESTMENTS
PHILIPPINE RETIREMENT AUTHORITY
29/F Citibank Tower, Paseo de Roxas, Makati City, 1227 Philippines
Tel. No. (632) 848-1412 Fax (632) 848-1411 Email: inquiry@pra.gov.ph Website: www.pra.gov.ph
Application No.
PRA Receipt
Date:
Please check one:
If not Principal, indicate Principal SRRV or
Principal Spouse Dependent below 21
Application No:
Last Name First Name Middle Name
Nationality Alias (AKA) Address in Home Country (No Post Office Box or Hotel please)
Telephone Mobile Fax Email
Address in the PHILIPPINES (No Post Office Box please)
Telephone Mobile Fax Email
Passport Number Place of Issue Date of Issue Expiration Date
Date of Birth Place of Birth Civil Status Religion
Sex Height Weight
Degrees Obtained
Graduate: ___________________________________________
School:
Present or Former Occupation or Business
Post Graduate: ____________________________________
School:
Field of Expertise
Last, First, Middle Name of Spouse
Spouse SRRV Application No.
Last, First, Middle Name of Children below 21 years old
SRRV Application No.
1. _____________________________________________________________
1. ________________________________
2. _____________________________________________________________ 2. ________________________________
Check a box if you have now or plan to set up business in the Philippines: 1. Have set up 2. Plan to set up 3. None
Fill in below if you checked 1 or 2:
Company Name
Address
Capital
Investment
(in US$)
%
Ownership
Date
Established or
to be
established
Products or
Services
Place passport size photo here taken
not more than 6 months ago
By affixing my signature, I hereby certify that the
information above are true and correct and that any
misrepresentation on my part will be ground for denial
of SRRV and/or revocation of my current Visa:
Signature of Applicant
Accomplish only if assisted by an
Accredited Marketer:
Registered Name of Marketer
PRA Accreditation Number
Address:
Date Signed
Tel: _____________________________

Page 2 – Special Resident Retiree’s Visa Application (Form PRA-RSC-2007-001) No. __________________________________________
INSTRUCTIONS: Please answer to the best of your knowledge:
1. Have you visited the Philippines within the past five (5) years Yes No. If Yes, how many times _____.
On the average, how long did you stay _______________.
2. How did you learn about the SRRV
PRA Website Brochure PRA Newsletter Newspaper Magazine
Friends, families, or associates TV Marketer Other Website
Others. Please specify: _____________________.
3. Which part of the Philippines do you particularly plan to stay longer
Baguio Clark Subic Metro Manila Tagaytay Cebu
Davao
Others. Please specify: _______________________.
INSTRUCTIONS: Please answer carefully to the best of your knowledge. The information you supplied will be subject to verification
from independent sources. Any misrepresentation will be ground for denial of SRRV and/or revocation of your current Visa:
1. Are you now afflicted or in the past, been afflicted with a loathsome, or dangerous contagious disease, or
epilepsy
No
Yes. Please specify: _____________________________________________________________
2. Are you now or in the past, been convicted of a crime involving moral turpitude No
Yes. Please specify:_______________________________________________________________________
3. Are you now being or in the past, been treated in a mental institution No
Yes. Please specify:_______________________________________________________________________
4. Are you now engaged or in the past, engaged in prohibited drugs or prostitution or human trafficking No
Yes. Please specify:_______________________________________________________________________
5. Do you believe in, advocate, or practice polygamy No
Yes. Please specify:_______________________________________________________________________
6. Do you believe in or in the past advocated the overthrow by force and violence of the any duly constituted
government, or of constituted lawful authority No
Yes. Please specify:_______________________________________________________________________
By affixing my signature, I hereby certify that the information above is true and correc.:
__________________________________
Sign above printed name of Applicant
__________________________________
Date Signed