ParadiseIslandForm.Version2021.

Samal TOURIST QR Code Application Form

Reminders:
1. All guests are required to have their respective QR Code per person;
2. QR code processing time may vary depending on Samal City LGU’s approval;
3. QR code is for single use only;
4. NO QR codes will be issued for kids below 10 years old; and
5. Send us back the accomplished application form along with all your gov’t issued valid IDs w/ address.

Day Tour: Overnight: X # of Room/s: Premier Room Deluxe Room

Reservation Date: from _________ to _________ Arrival Time: ____ ___

No. of Adults: _______ No. of Children (up to 12yrs old): ____________
Vehicle Plate #: _____ __ Entry Point: Private Terminal Public Ferry

EMAIL Address: _________________________________

(Samal City LGU will send to this email the QR codes once approved)

Guest # 1 / HEAD OF THE GROUP

Complete Name: Edil Mae Mendoza. Abad Age: ___37__
First Middle (complete) Surname
Gender: _Female_ Date of Birth: 01/18/1985__ Mobile #: 09177051885
Address: #16 Hiroshima St. Bambu Estate, Sto. Nino, Davao City, Davao del Sur_
Lot/Block/Street Barangay City Province

Guest # 2
Complete Name: Nathaniel Roy Paras Abad Age: ___48___
First Middle (complete) Surname
Gender: ___Male Date of Birth: 06/15/1974__ Mobile #: 09177221884
Address: #16 Hiroshima St. Bambu Estate, Sto. Nino, Davao City, Davao del Sur
Lot/Block/Street Barangay City Province

Guest # 3
Complete Name: Zachary Mendoza Abad Age: __7___
First Middle (complete) Surname
Gender: __Male_ Date of _05/08/2015_ Mobile #: ___n/a
Address: #16 Hiroshima St. Bambu Estate, Sto. Nino, Davao City, Davao del Sur
Lot/Block/Street Barangay City Province

Guest # 4
Complete Name: Tobias Mendoza Abad Age: __2___
First Middle (complete) Surname
Gender: __Male_ Date of Birth: _06/12/2020_ Mobile #: n/a
Address: #16 Hiroshima St. Bambu Estate, Sto. Nino, Davao City, Davao del Sur
Lot/Block/Street Barangay City Province

*All guests must fill-up the application form.*

 ParadiseIslandForm.Version2021.5

Guest # 5
Complete Name: Oscar Ibrahim Tapuyao Guiamadel Age: __37__
First Middle (complete) Surname
Gender: _Male_ Date of Birth: 01/07/1985 Mobile #: 09998864655
Address: #14 Nagasaki St. Bambu Estate, Sto. Nino, Davao City, Davao del Sur
Lot/Block/Street Barangay City Province

Guest # 6
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 7
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 8
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 9
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 10
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

*All guests must fill-up the application form.*

 ParadiseIslandForm.Version2021.5
Guest # 11
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 12
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 13
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 14
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

Guest # 15
Complete Name: N/A Age: ______
First Middle (complete) Surname
Gender: _______ Date of Birth: __ Mobile #:
Address: ___________________
Lot/Block/Street Barangay City Province

*All guests must fill-up the application form.*