PHILIPPINE RETIREMENT AUTHORITY No No No

Chinese
July 2013
SPECIAL RESIDENT RETIREE’S VISA APPLICATION
(Form PRA-RRSC-2013-02)
PHILIPPINE RETIREMENT AUTHORITY
29F Citibank Tower, Paseo de Roxas, Makati City, 1227 Philippines
Tel No. +632-848-1412, +632-848-1418; Fax No. +632-848-1411
E-mail: inquiry@pra.gov.ph; Website: pra.gov.ph
APPLICATION FORM FOR DEPENDENT RETIREE (Entries must be typewritten)
Attach 2” x 2” colored
photo taken not more
than 6 months ago
贴 入 近 6 个 月 内 的
2*2
□ Dependent - Spouse
□ Dependent - Child
Application No.
Last Name 姓
First Name 名
Alias (AKA) 别 名
Religion 宗 教
英 文
英 文
中 文
中 文
Gender 性 别
□ Male
□ Female
Civil Status
Date of Birth 出 生 日 期 Place of Birth 出 生 地 点 Nationality 国 籍
□Single 未 婚 □Married 已 婚 □ Divorced 离 婚 □ Widowed 丧 偶
ID No. 身 份 证 号
Height
Nationality 国 籍
Passport No. 护 照 号 码 Place of Issue 签 发 地 点 Date of Issue 签 发 日 期 Valid Until
Weight
Home Country Address (Please specify) 户 籍 地 址
Telephone No. 住 家 电 话
Fax No. 传 真 号 码
Mobile No. 手 机 电 话 号 码
E-mail 电 邮 信 箱
Primary
Primary Address in the Philippines
(Please specify) 现 居 住 地 址
Secondary Address in the Philippines
(Please specify) 现 居 住 地 址
Telephone No. 住 家 电 话
Fax No. 传 真 号 码
Mobile No. 手 机 电 话 号 码
E-mail 电 邮 信 箱
Principal Retiree Information
Name of Principal:
Included in this application □Yes □No (Please provide principal’s SRRV information)
SRRV No.
Date Issued
□ SMILE □ Classic □ Courtesy □ Human Touch
Family Information
For applying dependent-spouse please list name(s) of children below 21 years old; for applying
dependent-child, please list name(s) of siblings.
Name:
Date of Birth
出 生 日 期
Age 年 龄
ID No. (Required)
身 份 证 号
Included in your application
□Yes
□No
Name:
Date of Birth
出 生 日 期
Age 年 龄
ID No. (Required)
身 份 证 号
Included in your application
□Yes
□No
Name:
Date of Birth
出 生 日 期
Age 年 龄
ID No. (Required)
身 份 证 号
Included in your application
□Yes
□No

Chinese
July 2013
Name:
Name:
Date of Birth
出 生 日 期
Date of Birth
出 生 日 期
Age
年 龄
Age
年 龄
ID No. (Required)
身 份 证 号
ID No. (Required)
身 份 证 号
Included in your application
□Yes
□No
Included in your application
□Yes
□No
Parent’s Information 申 请 人 双 亲 信 息
Name of Father 父 亲 姓 名 :
英 文
中 文
Age
Name of Mother 母 亲 姓 名 :
英 文
中 文
Age
Name of Contact Person in
Case of Emergency
紧 急 联 络 人 姓 名
Contact No. 电 话 号 码 Nationality: 国 籍 : Relationship 关 系
Address
紧 急 联 系 人 地 址
Date of Arrival in the Philippines
计 抵 达 菲 律 宾 日 期
Expiration Date of Tourist
Visa / Others 旅 游 签 证 有 效 期 至
Entry Visa to the Philippines
持 何 种 签 证 入 境
Have you visited Philippines prior to this travel 在 此 之 前 是 否 有 来 访 过 菲 律 宾 □ Yes □ No
If the answer is “Yes”, What kind of entry visa
□ Tourist Visa 旅 游 签 证 □ Working Visa 工 作 签 证 □ Investment Visa 投 资 签 证
□ Missionary Visa 宗 教 签 证 □ Student Visa 学 生 签 证 □ Others (Please specify) _________________
Educational Attainment School and Location From/To (mm/yyyy - mm/yyyy)
曾 就 读 学 校 学 校 名 称 及 所 在 地 期 间 ( 月 / 年 )
1 _______________________________ __________________________ _______________________
2 _______________________________ __________________________ _______________________
3 _______________________________ __________________________ _______________________
By affixing my signature, I hereby certify that the information above are true and correct and that any misrepresentation on my
part will be grounds for denial of SRRV and/or revocation of my current Visa. I also commit to inform PRA in writing, of any
change of information presented here: 签 证 资
实 实 SRRV 销
Signature 签 证 处 of . Applicant:
Date Signed:
(To be accomplished by PRA Personnel)
_---------------------------------------------------------------------------------------------------------------------------------------
Date ----------------
of Receipt of Application Form: _____________________________
Papers Reviewed & Certified Complete by: (Please indicate complete name, designation, and long-form signature
Comments / Remarks:
_---------------------------------------------------------------------------------------------------------------------------------------
(To be accomplished upon issuance of SRRV)
----------------
_---------------------------------------------------------------------------------------------------------------------------------------
SRRV Number:
______________________________
----------------
Date of Issuance:
______________________________
Date of Oath-taking:
______________________________