Personal, Address, Phone, and Passport/Travel Document Information

Name Provided: Joaz Paolo V. Rosal

Full Name in Native Language: Joaz Paolo Vega Roal

Other Names Used:

Telecode Name Used:

Sex: Male

Marital Status: Single

Date of Birth: November 27 1981

Place of Birth: Quezon city

Nationality: Filipino

Other Nationalities:

National Identification Number:

U.S. Social Security Number:

U.S. Taxpayer ID Number:

Home Address: 178 j.p Rizal street project 4

City: Qeuzon City

State/Province: Metro Manila
Postal Zone/ZIP Code: 1109
Country/Region: Philippines
Same Mailing Address? Yes
Mailing Address:

City:
State/Province:
Postal Zone/ZIP Code:
 Country/Region:
Primary Phone Number: +639153788188
Secondary Phone Number: +6329118545
Work Phone Number:
Email Address: joazpaolorosal@gmail.com
Passport/Travel Document Type:
Passport/Travel Document Number: EC4816419
Passport Book Number: EC4816419
Country/Authority that Issued
DFA NCR NORTHEAST
Passport/Travel Document:
City Where Issued: Quezon City
Country/Region Where Issued: Phillipines
Issuance Date: Jul 15 2015
Expiration Date: Jul 30 2020
Have you ever lost a passport or had one
No
stolen?

Travel Information
The List of Purposes of Trip to the U.S.

TEMP. BUSINESS PLEASURE

Purpose of Trip to the U.S. (1):
VISITOR (B)
BUSINESS & TOURISM
Specify:
(TEMPORARY VISITOR) (B1/B2)
Intended Date of Arrival:
Intended Length of Stay in U.S.:
Address where you will stay in the U.S.:

City, State, Postal/Zip Code:

Person/Entity Paying for Your Trip: COMPANY/ORGANIZATION
Company/Organization Paying for the Trip: PACIFIC XTREME COMBAT, INC.
Telephone Number: 671 637 5832
OTHER, PACIFIC XTREME COMBAT,
Relationship to You:
INC.
Address of Company/Organization Paying: 600 BELLO STREET, STE 110
City: BARRIGADA
State/Province: GUAM
 Postal Zone/ZIP Code: 96913
Country/Region: UNITED STATES OF AMERICA
Are there other persons traveling with you? YES
Have you ever been in the U.S.?
Yes

Date Arrived (1): May 15 2014

Length of Stay: 6 Months
Date Arrived (2):
Length of Stay:
Do you or did you hold a U.S. Driver's
No
License?
Have you ever been issued a U.S.
Yes
Visa?
Date Last Visa was Issued: Jan 29 2008
Visa Number: 20O8O25739O0O6
Are you applying for the same type of
No
visa?
Are you applying in the same country
where the visa above is issued and is this
Yes
country your principal country of
residence?
Have you been ten-printed? No
Has your U.S. Visa ever been lost or
No
stolen?
Has your U.S. Visa ever been cancelled
No
or revoked?
Have you ever been refused a U.S. Visa,
been refused admission to the United
No
States, or withdrawn your application for
admission at the port of entry?
Has anyone ever filed an immigrant petition
on your behalf with the United States No
Citizenship and Immigration Services?
No
Have you traveled to any countries within
No
the last five years other than the US?
Please list these countries

U.S. Contact Information

Contact Person Name in the U.S.: CALVO , EDWARD JOHN
Organization Name in the U.S.: PACIFIC XTREME COMBAT, INC.
Relationship to You: OTHER
U.S. Contact Address: 600 BELLO STREET, STE 110
BARRIGADA , GUAM 96913
Phone Number: 671 637 5832
Email Address: ejcalvo@pacificxtremecombat.com
Family Information
Father's Surnames: Rosal
Father's Given Names: Mauricio
Father's Date of Birth: Sept 22
Is your father in the U.S.? No
Mother's Surnames: Vega, Rosal
Mother's Given Names: Gloria
Mother's Date of Birth: Apr 24
Is your mother in the U.S.? No
Do you have any immediate relatives, not
Yes
including parents in the U.S.?
Do you have any other relatives in the
Yes
United States?
Work/Education/Training Information
College/Highschool Name: ACTEC
Year attended: 2016
Address: 727 edsa tri building pinagkaisahan cubao

City: Quezon City

State/Province: Metro Manila
Postal Zone/Zip Code: 1109
Country/Region: Philippines
Primary Occupation: Shipping chain manager
Present Employer or School Name: Medisina
Address: Unit 19 Cubao Expo
 City: Quezon City
State/Province: Metro Manila
Postal Zone/Zip Code: 1109
Country/Region: Philippines
Work Phone Number: +632 2940630
Monthly Salary in Local Currency (if
8,000 php
employed):
Handling shipping, providing customer
Briefly Describe your Duties:
service
Name of Previous Employer (1), if any: Willabaliw
Employment Date (Exact Date From and
2009- 2013
To):
Address: Manila, Philippines

Job Title Sound engineer / visual artirt

Briefly describe duties Provide quality sound/ lights
Name of Previous Employer (2), if any: Sinosikat
Employment Date (Exact Date From and
2006 -2009
To):
Address: Manila, Philippines

Job Title Sound engineer

Briefly describe duties Providing quality sound

Name of School, (College or High School,

ACTEC
whichever is applicable):
Course: Caregiving
Date Attendance (School Year From and
2016
To):
727 EDSA tri building pinagkaisahan
Address:
cubao, Quezon City

Security and Background Information

Do you have a communicable disease of public health significance? no
(Communicable diseases of public significance include chancroid, gonorrhea,
granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious
stage syphilis, active tuberculosis, and others diseases as determined by the
Department of Health and Human Services.)
Do you have a mental or physical disorder that poses or is likely to pose a threat
No
to the safety or welfare of yourself or others?
Are you or have you ever been a drug abuser or addict? No
No
Have you ever been arrested or convicted for any offense or crime, even though
No
subject of a pardon, amnesty, or other similar action?
Have you ever violated, or engaged in a conspiracy to violate, any law relating to
No
controlled substances?
Are you coming to the United States to engage in prostitution or unlawful
commercialized vice or have you been engaged in prostitution or procuring No
prostitutes within the past 10 years?
Have you ever been involved in, or do you seek to engage in, money laundering? No
Have you ever committed or conspired to commit a human trafficking offense in
No
the United States or outside the United States?
Are you the spouse, son, or daughter of an individual who has committed or
conspired to commit a human trafficking offense in the United States or outside
No
the United States and have you within the last five years, knowingly benefited
from the trafficking activities?
Have you knowingly aided, abetted, assisted or colluded with an individual who
has committed or conspired to commit a severe human trafficking offense in the No
United States or outside the United States?
Do you seek to engage in espionage, sabotage, export control violations, or any
No
other illegal activity while in the United States?
Do you seek to engage in terrorist activities while in the United States or have
No
you ever engaged in terrorist activities?
Have you ever or do you intend to provide financial assistance or other support to
No
terrorists or terrorist organizations?
Are you a member or representative of a terrorist organization? No
Have you ever ordered, incited, committed, assisted, or otherwise participated in
No
genocide?
Have you ever committed, ordered, incited, assisted, or otherwise participated in
No
torture?
Have you committed, ordered, incited, assisted, or otherwise participated in
No
extrajudicial killings, political killings, or other acts of violence?
Have you ever engaged in the recruitment or the use of the child soldiers? No
Have you, while serving as a government official, been responsible for or directly No
carried out, at any time, particularly severe violations of religious freedom?
Have you ever been directly involved in the establishment or enforcement of the
population controls forcing a woman to undergo an abortion against her free No
choice or a man or a woman to undergo sterilization against his or her free will?
Have you ever been directly involved in the coercive transplantation of human
No
organs or bodily tissue?
Have you ever been the subject of a removal or deportation hearing? No
Have you ever sought to obtain or assist others to obtain a visa, entry into the
United States, or any other United States immigration benefit by fraud or willful No
misrepresentation or other unlawful means?
Have you failed to attend a hearing on removability or inadmissibility within the
No
last five years?
Have you ever been unlawfully present, overstayed the amount of time granted by
No
an immigration official or otherwise violated the terms of a U.S. visa?
Have you ever withheld custody of a U.S. citizen child outside the United States
No
from a person granted legal custody by a U.S. court?
Have you voted in the United States in violation of any law or regulation? No
Have you ever renounced United States citizenship for the purpose of avoiding
No
taxation?
Have you attended a public elementary school on student (F) status or a public
No
secondary school after November 30, 1996 without reimbursing the school?
Location Information
Location where you will be submitting your application
Current Location: MANILA, PHILIPPINES
Preparer of Application
Did anyone assist you in filling out this
Yes
application?
Preparer Surnames: Camcam
Preparer Given Names: Cherrie Lee
Organization Name: Calvo Tropical Productions, Inc.
Street Address: 2A Blue Sapphire Residences, 30th Street
Corner 2nd Avenue, Bonifacio Global City
City: Taguig City
State/Province: Metro Manila
Postal Zone/ZIP Code: 1634
Country/Region: Philippines
Relationship to You: Colleague