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2015-08-002 Rev 0 ACR I-Card Renewal
BI application form for alien certificate of registration identity card renewal
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This document cannot be reproduced and is NOT FOR SALE
APPLICATION FOR RENEWAL OF ALIEN CERTIFICATE OF
REGISTRATION IDENTITY-CARD (ACR I-CARD)
CONTROL NO:
APPLICATION NO:
TRANSACTION/S
ACR I-Card Renewal
ACR I-Card Renewal
DEROGATORY RECORD
Expired ACR I-Card
Re-registration (14 yrs. old)
NO DERO
ACR Replacement
Change of Visa Status
W/ DERO
Checked by : _____________________________
\
ACR I-Card Re-issuance
Lost Card
Date
Rejected Card
Damaged Card
: ____________________________
RECOMMENDING
To effect new card validity
APPROVAL
Amendments (Name/Nationality/Civil Status/Address/*Others)
OTHERS:
RP/SRC Issuance/Extension/Re-issuance
DENIAL
Remarks: _______________________________
________________________________________
Annual Report with Fine
CHANGE OF ADDRESS:
________________________________________
New Address:
Registration Officer
___________________________________________________________________________
Date
REVIEWED BY:
___________________________________________________________________________
___________________________________________________________________________
________________________________________
Remarks:
APPROVED BY:
Reviewing Officer
Date
___________________________________________________________________________
___________________________________________________________________________
________________________________________
___________________________________________________________________________
ARE YOU PLANNING TO LEAVE THE COUNTRY WITHIN THIRTY (30) DAYS UPON
ACR Number
COMM/ARD CHIEF
ISSUANCE OF ACR I-CARD?
Certificate of Residence Number
Date
YES
NO
Visa Status
Last Name
Valid Authorized Stay [DD-MMM-YYYY e.g. 01 JAN 1990]
First/Given Name
Age
Gender
Middle Name
Height [cm]
Weight [Kg]
Male
Female
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]
Civil Status
Passport Number
Date of Issuance [DD-MMM-YYYY e.g. 01 JAN 1990]
Expiry Date/ Valid [DD-MMM-YYYY e.g. 01 JAN 1990]
Citizenship/Nationality
Landline Number
Mobile Number
Single
Married
Annulled
Separated
Widowed
Separated
Email Address
Residential Address in the Philippines
House/Unit No., Street, Subdivision/Village, Barangay
Municipality/City, Province, Zip Code
If applicant is married, indicate the name and citizenship/nationality of spouse:
Name of Spouse [Last Name, First/Given Name, Middle Name]
Citizenship of Spouse
I hereby swear/affirm that the information provided herein are true and correct to the best of my knowledge and belief. I
voluntarily submitted authenticated/original documents/card to further verify my application and that any misrepresentation, omission or
falsification of facts may justify denial and cancellation of my application. Further, I have no pending application not given due course in
other immigration office.
Date [DD-MMM-YYYY e.g. 01 JAN 1990]
Applicant’s Signature over Printed Name
APPLICANT’S ACR I-CARD CLAIM STUB
Applicant’s Name [Last Name, First/Given Name, Middle Name (Please leave a box after each name)]
ACR Number
Visa Type
[IF THE ACR I-CARD IS CLAIMED BY AN AUTHORIZED REPRESENTATIVE, PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS.]
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BI FORM 2015-08-002 Rev 0
This document cannot be reproduced and is NOT FOR SALE
APPLICATION FOR RENEWAL OF ALIEN CERTIFICATE OF REGISTRATION
IDENTITY CARD (ACR I-CARD)
Name of Representative _________________________________
Accredited Travel Agency/Law Office _______________________
BI Accreditation No. _____________________________________
Contact No. ___________________________________________
Residential /Office Address _______________________________
Signature _____________________________________________
1.
2.
3.
4.
ACR I-CARD WILL ONLY BE RELEASED UPON COMPLIANCE/SUBMISSION OF THE FF:
Photocopy of passport bio-page of the ACR I-Card holder
Valid ID of either parent claiming the ACR I-Card, if applicant is a minor
Photocopy of the BI-Accreditation ID card, if claimed by a travel agent or law firm
Special Power of Attorney (SPA), if claimed by an authorized representative other than the
parent or BI accredited entity
ACR I-Card Holder: _________________________
Signature over PRINTED NAME
Claimant:_____________________
Signature
[Please call (+632) 525-7557 to check the status of your application]
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