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

SPECIAL RESIDENT RETIREE'S VISA APPLICATION(Form PRA-RSC-2007-001)Republic of the PhilippinesBOARD OF INVESTMENTSPHILIPPINE RETIREMENT AUTHORITY29/F Citibank Tower, Paseo de Roxas, Makati City, 1227 PhilippinesTel. No. (632) 848-1412 Fax (632) 848-1411 Email: inquiry@pra.gov.ph Website: www.pra.gov.phApplication No.PRA Receipt Date:Please check one:Principal Spouse Dependent below 21If not Principal, indicate Principal SRRV orApplication No:Please choose visa option:Without Pension With Pension Brain GainLast Name First Name Middle NameNationality Alias (AKA) Address in Home Country (No Post Office Box or Hotel please)Telephone Mobile Fax EmailAddress in the PHILIPPINES (No Post Office Box or Hotel please)Telephone Mobile Fax EmailPassport Number Place of Issue Date of Issue Expiration DateDate of Birth Place of Birth Civil Status ReligionSex Height WeightDegrees ObtainedGraduate:School:Present or Former Occupation or BusinessPostgraduate:School:Field of ExpertiseLast, First, Middle Name of SpouseSpouse SRRV Application No.Last, First, Middle Name of Children below 21 years old1.2.SRRV Application No.1.2.Select if you have now or plan to set up business in the Philippines:Fill in below if you selected 1 or 2:Company NameAddressCapitalInvestment(in US$)1. Have set up 2. Plan to set up 3. None%OwnershipDateEstablished orto beestablishedProducts orServicesBy affixing my signature, I hereby certify that theinformation above are true and correct and that anymisrepresentation on my part will be ground for denialof SRRV and/or revocation of my current Visa:Accomplish only if assisted by anAccredited Marketer:Registered Name of MarketerClick to insert 2x2 photo here takennot more than 6 months agoSignature of ApplicantPRA Accreditation NumberAddress:Date SignedTel:

Page 2 - Special Resident Retiree's Visa Application 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 MagazineFriends, families, associates TV Marketer Other websitesOthers. Please specify:3. Which part of the Philippines do you particularly plan to stay longer?Baguio Clark Subic Metro Manila Tagaytay CebuDavaoOthers. Please specify:Please read carefully:The following classes of aliens shall be excluded from entry into the Philippines and are not eligible to acquire aSpecial Resident Retiree's Visa:1. Mentally-challenged or insane persons or persons afflicted with a dangerous contagious disease, or epilepsy;2. Paupers, vagrants, and beggars, persons likely to become a public charge, stowaways, persons who havebeen excluded or deported from the Philippines including those deported as indigent aliens, or persons notproperly documented for admission;3. Persons who have been convicted of a crime involving moral turpitude, prostitutes or procurers, personscoming for any immoral purposes, and persons who practice polygamy or who believe in or advocate thepractice of polygamy;4. Persons who believe in or advocate the overthrow by force and violence of the Government of the Philippines,or of constituted lawful authority, or who disbelieve in or are opposed to organized government;5. Persons over fifteen years of age, physically capable of reading, who cannot read printed matter in ordinaryuse in any language selected by the alien, persons who are members of a family accompanying an excludedalien; or6. Persons coming to perform unskilled manual labor in pursuance of a promise or offer of employment;*The mere act of submitting this form, for the purpose of processing the application, is an affirmation that theapplicant is not an excluded nor a disqualified person based on existing Philippine Immigration laws.