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VCU Form 1

The document is a request form for certification from the Bureau of Immigration. It requests certification for an individual's name, date of birth, nationality, and other information. It specifies the type of certification being applied for, which includes BI Intelligence Clearance (pending application), Certified True Copy, and others. It provides instructions on documentary requirements and payment procedures.

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Michael Villame
Copyright
© Attribution Non-Commercial (BY-NC)
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Download as DOC, PDF, TXT or read online on Scribd
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404 views2 pages

VCU Form 1

The document is a request form for certification from the Bureau of Immigration. It requests certification for an individual's name, date of birth, nationality, and other information. It specifies the type of certification being applied for, which includes BI Intelligence Clearance (pending application), Certified True Copy, and others. It provides instructions on documentary requirements and payment procedures.

Uploaded by

Michael Villame
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
Download as doc, pdf, or txt
Download as doc, pdf, or txt
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REQUEST FOR CERTIFICATION

(Check the type of certfcaton you are appyng for. Pease provde the nformaton beng asked.)
BI Intelligence Clearance Pending Application
|No Derogatory Record| |Immgrant & Non-Immgrant Vsa|
Certified True Copy OTHERS
|Bureau of Immgratons Certfcates| |Pease specfy|
________________________

Date: ______________, 200_
THE COISSIONER
THIS BUREAU
Dear Sr/Madam :
May I request a certfcaton for:
SURNAME
FIRST NAME
MIDDLE NAME
OTHER NAME
Purpo!e" ______________________________________________________
OTHER INFORATION
SEX M F
DATE OF BIRTH / /
PLACE OF BIRTH
NATIONALITY
PHILIPPINE ADDRESS
PASSPORT NO.
TEL. NO./CEL. NO
#ery truly your!$
______________________
SI%NATURE of Requestng Party
___________________________
PRINTE& NAE of Requestng Party
NOTE : Please see BACK PAGE for LIST OF DOCUMENTARY REQUIREMENTS for sub!ss!o"#
$CU For %
Bureau of I!&ra'!o"
$er!f!(a'!o" ) Cer'!f!(a'!o" U"!'
C ' A I S T U B
BI I"'ell!&e"(e Cleara"(e PENDING A**l!(a'!o" CTC +Cer'!f!e, True Co*-.
Nae of Sub/e(' : 00000000000000000000000000000000000000000000000000000000000
Da'e of B!r'1 : 000000000000000000 Na'!o"al!'- : 00000000000000000000000000
FRONT PAGE
SPECIFIC REQUIREENT! "
Month / Day / Year
Verification of
DEROGATORY +2DO3BL34L.
NAIA 1
Verifier ________________
Date/Time ______________
NAIA 2
Verifier ________________
Date/Time ______________
$CU For %
THIS FORM IS NOT FOR SALE
REPROD!"TION IS ALLO#ED
$an% 2&&'
DATE 3 TIME
RECEI$ED
$CU 5!",o5
((((((((((((((
2 to ( )o*r+ ,roce++in- *,on ,a.ment /e,en/in- on t)e 0o1*me of a,,1ication
A12a.+ ,re+ent t)i+ recei,t *,on c1aimin- .o*r certificate
!nc1aime/ certificate +)a11 3e a*tomatica11. cance11e/ after (& /a.+ from t)e /ate of i++*ance
If not t)e c1aimant of certificate ,re+ent an. 0a1i/ ID "ar/+
&ATE ) TIE FI'E&"
&ATE ) TIE relea!ed "*
BI INTELLIGENCE CLEARANCE :
Attac)e/ 4ERO4 "OP5 of PASSPORT
PENDING APPLICATION :
Attac)e/ 4ero6 co,. of a,,1ication 7+tam, recei0e/8
CERTIFIFIED TRUE COPY :
Procee/ to Room (&1 (
r/
F1oor at Recor/+ Section
CERTIFICATION FEE+S "
"ertification 9&&%&&
Le-a1 Re+earc) 1&%&&
E6,re++ Fee 9&&%&&
T O T A L P1 P %67%7#77
"o11ecte/ *n/er "%A% No% :1(
Section ;27A871<8
#it) MEMORANDUM ORDER NO# 7897:; /ate/ 8< Se*'eber 8778
FOR PEN&IN% APP'ICATION ON',
PENDING APPLICATION= _________________
Si-nat*re = _________________
Printe/ Name= _________________
Office = _________________
Date = _________________
>A"? PAGE
PROCEDURE:
A,,1icant+ +)o*1/ 0erif. 2it) t)eir a++i-ne/ >ID La2.er+ an/ fi11 *, t)e a3o0e ,ortion% A''a(1 a *1o'o(o*- of '1e
*e",!"& a**l!(a'!o"#
After accom,1i+)in- t)i+ form t)e a,,1icant +)o*1/ +ec*re an Or/er Pa.ment S1i, @OPSA an/ ,a. t)e amo*nt at t)e
"a+)ier% After ,a.ment ,re+ent t)e Officia1 Recei,t @ORA to-et)er 2it) t)i+ form at t)e Verification B "ertification !nit in
or/er to ,roce++ t)e "ertification%

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