All of the following questions apply to the Primary Applicant’s child either biological, adopted, step

child, or any other dependents. Please read the questions carefully and do not leave any questions
blank. If the question does not apply to you, please mark as “N/A”

1. Answer the following questions about the Primary Applicant’s child. If you have more than one
child, copy and paste the table below as needed.

First Name: Sweet Dominique

Middle Name: Baluran
Last Name: Amatong
Sex: Female
Date of birth (YYYY-MM-DD): 2014-07-12
Place of birth: Davao City, Philippines
Citizenship: Filipino
Complete address of current residence: Blk 15 Lot 4 Sampaguita St. Green Meadows
Subd., Mintal, 8000 Davao City, Philippines
What is your native language? (Tagalog, English
Ukrainian, French, Fijian, etc.)
Can you speak English? Yes
Mother’s first name: Lida Fe
Mother’s middle name: Dimpas
Mother’s last name: Baluran
Mother’s complete current address: Blk 15 Lot 4 Sampaguita St. Green Meadows
Subd., Mintal, 8000 Davao City, Philippines
Mother’s date of birth (YYYY-MM-DD): 1974-09-12
Mother’s place of birth (City, Country): Kapalong, Davao del Norte, Philippines
Mother’s current occupation: Self-employed
Mother’s current marital status: Common-law partner
If deceased, please specify date of death (YYYY- N/A
MM-DD):
If deceased, please specify place of death (City, N/A
Country):
Father’s first name: John Fourth
Father’s middle name: Obeso
Father’s last name: Amatong
Father’s complete current address: Blk 15 Lot 4 Sampaguita St. Green Meadows
Subd., Mintal, 8000 Davao City, Philippines
Father’s date of birth (YYYY-MM-DD): 1981-01-04
Father’s place of birth (City, Country): Davao City, Philippines
Father’s current occupation: Butcher/Meat cutter
Father’s current marital status: Common-law
If deceased, please specify date of death (YYYY- N/A
MM-DD):
If deceased, please specify place of death (City, N/A
Country):
 2. Please complete the following education information below for the Primary Applicant’s child. If
you have more than one child, copy and paste the table below as needed.

How many years of school have you successfully completed?

Elementary/Primary Secondary/High University/College: Trade School or other

School: School: post-secondary
school:
1 N/A N/A N/A

3. For the Primary Applicant’s child, please provide a list of addresses that the child has lived at
since the age of 18. This includes any school dormitories, any out of country residences, and
any part-time and full-time residencies. Please do not leave any time gaps. Please include the
exact months from which you moved to and moved away from each residence.

From: To: Street and City or Province, Postal Country:

YYYY-MM YYYY-MM number: town: state, or code/zip
district: code:
N/A N/A N/A N/A N/A N/A N/A

Please go back and review each question before submitting. It is important you answer each question
correctly and follow each instruction carefully. Failure to do so may result in a delay in our ability to
submit your application.

If you are filling out this form for your child, please indicate your relationship: Father

I, John Fourth Amatong, hereby certify the information listed above to be accurate and truthful.

________________________________ _____________________________
Signature Date
All of the following questions apply to the Primary Applicant’s child either biological, adopted, step
child, or any other dependents. Please read the questions carefully and do not leave any questions
blank. If the question does not apply to you, please mark as “N/A”

1. Answer the following questions about the Primary Applicant’s child. If you have more than
one child, copy and paste the table below as needed.

First Name: Stephen John

Middle Name: Baluran
Last Name: Chang
Sex: Male
Date of birth (YYYY-MM-DD): 1999-03-29
Place of birth: Davao City, Philippines
Citizenship: Filipino
Complete address of current residence: Blk 15 Lot 4 Sampaguita St. Green Meadows
Subd., Mintal, 8000 Davao City, Philippines
What is your native language? (Tagalog, Tagalog
Ukrainian, French, Fijian, etc.)
Can you speak English? Yes
Mother’s first name: Lida Fe
Mother’s middle name: Dimpas
Mother’s last name: Baluran
Mother’s complete current address: Blk 15 Lot 4 Sampaguita St. Green Meadows
Subd., Mintal, 8000 Davao City, Philippines
Mother’s date of birth (YYYY-MM-DD): 1974-09-12
Mother’s place of birth (City, Country): Davao del Norte, Philippines
Mother’s current occupation: Self-employed
Mother’s current marital status: Common-law partner
If deceased, please specify date of death (YYYY- N/A
MM-DD):
If deceased, please specify place of death (City, N/A
Country):
Father’s first name: Ting Chia
Father’s middle name: Tan
Father’s last name: Chang
Father’s complete current address: Blk.6 Telok Blangah Crescent #10-424, Singapore
Father’s date of birth (YYYY-MM-DD): 1954-02-20
Father’s place of birth (City, Country): Singapore
Father’s current occupation: Self-employed
Father’s current marital status: Divorced
If deceased, please specify date of death (YYYY- N/A
MM-DD):
If deceased, please specify place of death (City, N/A
Country):
 2. Please complete the following education information below for the Primary Applicant’s
child. If you have more than one child, copy and paste the table below as needed.

How many years of school have you successfully completed?

Elementary/Primary Secondary/High University/College: Trade School or other

School: School: post-secondary
school:
6 6 3 N/A

3. For the Primary Applicant’s child, please provide a list of addresses that the child has lived
at since the age of 18. This includes any school dormitories, any out of country residences,
and any part-time and full-time residencies. Please do not leave any time gaps. Please
include the exact months from which you moved to and moved away from each
residence.

From: To: Street and City or Province, Postal Country:

YYYY-MM YYYY-MM number: town: state, or code/zip
district: code:
2017- 2021-July Blk 15 Lot 4 Green Mintal, 8000 Philippines
March Sampaguita Meadows Davao City
St. Subd.,
N/A N/A N/A N/A N/A N/A N/A

Please go back and review each question before submitting. It is important you answer each question
correctly and follow each instruction carefully. Failure to do so may result in a delay in our ability to
submit your application.

If you are filling out this form for your child, please indicate your relationship: Stepfather

I, John Fourth Amatong, hereby certify the information listed above to be accurate and truthful.

________________________________ _____________________________
Signature Date