2014-01-011 Rev 0 Reconsideration on the Updating and Extension of Authorized Stay Request

BI request form for reconsideration in updating and extension of authorized stay

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REQUEST FOR RECONSIDERATION ON THE
UPDATING AND EXTENSION OF AUTHORIZED STAY
__________________________
Date [DD-MMM-YYYY e.g. 01 JAN 1990]

The Honorable
COMMISSIONER
Bureau of Immigration
Magallanes Drive
Intramuros, Manila
REQUEST FOR RECONSIDERATION ON THE
UPDATING AND EXTENSION OF AUTHORIZED STAY
I,_____________________________________________________, born on ____________________________,
(Last Name, First Name, Middle Name)
Date [DD-MMM-YYYY e.g. 01 JAN 1990]

□single

□married

□annulled

□widow

□separated

□divorced,

a citizen of

_________________________
(Civil Status)
(Nationality)
with contact number (s) _________________________________, respectfully request from your good office for the
(Contact Information)
updating and/or extension of my authorized stay as a tourist.
I failed to extend my authorized stay as a tourist for the reason that ____________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________.
I would like to stay longer in this country because __________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________.
My authorized stay expired on __________________________________ and from that time on, NO extension
has been made. I am willing to pay all the necessary fees, fines and penalty to regularize my stay.
*If the applicant/petitioner intends to depart the country within a month or two, attach a copy of a confirmed departure
ticket and an original affidavit that he/she will be leaving the Philippines.
I will be leaving the Philippines on _________________________ bound to _____________________________.
(Date of Departure)
(Final Destination)
Rest assured that I will never again allow myself to be an overstaying foreign national in this country and will not
in any manner, violate any law, policy, rules and regulations imposed by the Philippine Government.
Hoping for your favorable action on this request.
______________________________________
(Signature over Printed Name)
If filed by a Representative:
If filed by a representative, please attach a photocopy of valid
government-issued identification and Special Power of Attorney (SPA).
____________________________
(Signature over Printed Name)

Representative Accreditation No.
Relationship to the Subject

:
:

___________________________
___________________________

Website: www.immigration.gov.ph
E-mail: xinfo@immigration.gov.ph
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