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Principal and Dependent Application Form
TIEZA visa application form for principal and dependent
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: TOURISM INFRASTRUCTURE AND ENTERPRISE ZONE AUTHORITY
T-IAD-SIRV
8th
Flr., 142 Amorsolo St., Legaspi Village, Makati City 1229
Website: www.tieza.com.ph
E – mail: tez.secretariat@gmail.com
Tel no.: (+632) 4639936 ; (+632) 5519556
Application no.______________
SPECIAL INVESTOR’S RESIDENT VISA APPLICATION FORM
DIRECTION:
1.
2.
3.
4.
5.
6.
7.
Attach your 2x2 colored photograph
with white background using
permanent glue in the permanent
photograph box.
Fill out the form properly and completely
Mark the box with “X” or “N/A” if not applicable. Do not leave any blank spaces
Write legibly on the application form
Application form with any erasure or alteration will not be accepted
Application form must be notarized upon submission
Requirements must be completely attached with the application form
To be accomplished in Triplicate copies
The photograph must be taken within
the last three months from the date
of application.
A scanned photograph is not allowed.
A photograph of the applicant
wearing eyewear or headwear is not
acceptable
TYPE OF APPLICATION
_______ PRINCIPAL
________ SIRV DEPENDENT
METHOD OF APPLICATION
_______ PERSONAL
________ AUTHORIZED REPRESENTATIVE
*For application filed by an authorized representative
Name:
_________________________________________________________________________________________________
Address:
_________________________________________________________________________________________________
Contact Information:
Mobile/Landline:
_____________________________
E-mail: ________________________________
APPLICANTS TRAVEL INFORMATION
NATIONALITY
DATE OF ISSUE (dd/mm/yyyy)
PASSPORT NO.
PLACE OF ISSUANCE
DATE OF EXPIRY(dd/mm/yyyy)
DATE OF LATEST ARRIVAL(dd/mm/yyyy)
CARRIER NUMBER
PERSONAL INFORMATION
LAST NAME
FIRST NAME
ALIAS
DATE OF BIRTH
COUNTRY OF BIRTH
MAIDEN NAME
(DD/MM/YYYY)
AGE
SEX
STATUS
HOME COUNTRY ADDRESS
PHILIPPINE ADDRESS
HEIGHT (cm)
WEIGHT (kg)
CONTACT NO. (HOME COUNTRY)
E-MAIL ADDRESS
NAME OF TEZ OR RTE
CONTACT NO. (PHILIPPINES)
DESIGNATION / REGISTRATION NO.
Last three years of residence
Period of Stay (mm/yyyy-mm/yyyy)
Address
1.____________________________
_____________________________________
2.____________________________
3.____________________________
FAMILY MEMBER INFORMATION
(Applicant may use extra sheet if needed)
SPOUSE
LAST NAME
FIRST NAME
ALIAS
DATE OF BIRTH
PLACE OF BIRTH
HOME COUNTRY ADDRESS
PHILIPPINE ADDRESS
PASSPORT NUMBER OF
APPLICANT
INCLUDED IN THE APPLICATION?
__________YES ____________NO
MAIDEN NAME
(DD/MM/YYYY)
AGE
SEX
STATUS
NATIONALITY
CONTACT NO. (HOME COUNTRY)
E-MAIL ADDRESS
PLACE OF ISSUE
CONTACT NO. (PHILIPPINES)
DATE OF ISSUE
DATE OF EXPIRY (DD/MM/YYYY)
(DD/MM/YYYY)
TOURISM INFRASTRUCTURE AND ENTERPRISE ZONE AUTHORITY
T-IAD-SIRV
8th
Flr., 142 Amorsolo St., Legaspi Village, Makati City 1229
Website: www.tieza.com.ph
E – mail: tez.secretariat@gmail.com
Tel no.: (+632) 4639936 ; (+632) 5519556
CHILDREN (not more than 18 years of age)
LAST NAME
FIRST NAME
ALIAS
DATE OF BIRTH
PLACE OF BIRTH
HOME COUNTRY ADDRESS
PHILIPPINE ADDRESS
PASSPORT NUMBER OF
APPLICANT
MAIDEN NAME
(DD/MM/YYYY)
AGE
SEX
STATUS
NATIONALITY
CONTACT NO. (HOME COUNTRY)
E-MAIL ADDRESS
PLACE OF ISSUE
CONTACT NO. (PHILIPPINES)
DATE OF ISSUE
DATE OF EXPIRY (DD/MM/YYYY)
(DD/MM/YYYY)
INCLUDED IN THE APPLICATION?
__________YES ____________NO
I hereby certify that these are true and correct statements including those of my spouse and unmarried children below eighteen (18) years of
age living in my household to the best of my knowledge.
I hereby authorize TIEZA or his/her duly authorized representative/s to obtain and secure from all appropriate government agencies, including
my DEPOSITORY BANK/s such documents that may show my assets, liabilities, net worth, business interests and financial connections
covering previous years to include the year I first applied for TSIRV.
____________________________________
Applicant’s Signature over Printed Name
______________________
Date
SUBSCRIBED AND SWORN to before me this _______ day of ___________, affiant exhibiting to me his/her government issued identification card.
Doc. No ________
Series No. ______
Book No. _______
Notary Public
Application and Documents Reviewed by:
_________________________
Name of Verifier
________________________
Signature
___________________
Date
Comments / Remarks:
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
