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Consolidated General Application Form Immigration Regulation Division

The document is a consolidated general application form for immigration regulation division that collects an applicant's personal information such as name, date of birth, citizenship, passport details, contact information, and address for applications related to transferring admission status, amending admission status, or correcting a failed process. The applicant must certify that the information is true and consents to their personal data being held according to privacy laws, and an immigration officer and supervisor must sign off on the application.

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Andrean Linata
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393 views1 page

Consolidated General Application Form Immigration Regulation Division

The document is a consolidated general application form for immigration regulation division that collects an applicant's personal information such as name, date of birth, citizenship, passport details, contact information, and address for applications related to transferring admission status, amending admission status, or correcting a failed process. The applicant must certify that the information is true and consents to their personal data being held according to privacy laws, and an immigration officer and supervisor must sign off on the application.

Uploaded by

Andrean Linata
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BI FORM NO. IRD01.QF.006 REV.

03 This document may be reproduced and is NOT FOR SALE


CONSOLIDATED GENERAL APPLICATION FORM
IMMIGRATION REGULATION DIVISION
Last Name

First/Given Name

Middle Name

Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990] Citizenship/Nationality

Passport Number [Old] Landline Mobile

Passport Number [New] Email Address

Latest Date of Arrival [DD-MMM-YYYY e.g. 01 JAN 1990] Flight Number BIBS No. Status of Admission

Residential/Registered Address in the Philippines


Application: [please check]

Transfer of Admission Status

Amendment/Correction of Admission Status

Failed to Check
DATA PRIVACY CONSENT
Failed to Encode By completing this form, I give permission for my data to be held in the Bureau of Immigration
database and agree that BI may process my personal data relating to my application in
Failed to Stamp accordance with the Data Privacy Act of 2012 (R.A. 10178).

________________________
Signature over PRINTED NAME of
Applicant or Authorized Representative
Reason/Explanation
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________

CERTIFICATION
I/We certify that: 1. All information in the application is truthful, complete and correct; 2. All documents are authentic and were legally obtained from the
corresponding government agencies and private entities; 3. I/We understand that my/our application may be summarily denied if : a. Any statement is
false; b. Any documents submitted is falsified; or c. I/We fall to comply with all the BI requirements without prejudice to whatever action the BI may take;
and 4. I/We have not filed this or any similar application before any office of the Bureau.

_______________________________
Signature over PRINTED NAME of Applicant
or Authorized Representative Date [DD-MMM-YYYY e.g. 01 JAN 1990]

[To be filled out by Authorized BI Personnel Only]

IRD STAMP/NOTATION NO DEROGATORY RECORD STAMP

___________________ ___________________
Signature over PRINTED NAME Signature over PRINTED NAME
Immigration Officer Reviewer/Supervisor

DOCUMENTS RELEASED TO: ____________________________ DATE: ___________ TIME: __________


Signature over PRINTED NAME [DD-MMM-YYYY]

IRD01.QF.006 effective 08 October 2020 Rev 03

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