Republic of the Philippines

Foreign Service of the Philippines

Jakarta Philippine Embassy
APPLICATION FOR NON-IMMIGRANT VISA TO THE PHILIPPINES
Surname: LI Given Name: HAINING
Place of Birth: Date of Birth: Age: Sex:
SHANDONG 1980-02-07 42 MALE
Applicant's address: Contact No.: 8613918503369
1509 BUILDING 172 SHANGHAI SHANGHAI 200000 Email Address:
lihaining@gmail.com
Occupation: Office of Employment and Address: Contact No.:
EMPLOYED ENVISION ENERGY SHANGHAI HUANGPU 8602160318000
DISTRICT 736 FIRST SOUTH ZHONGSHAN
ROAD TOWER B ONE EAST PLAZA
Civil Status: Country of Citizenship:
MARRIED CHINA
Passport/Travel Document no.: Date of Issue: Valid Until:
E73543090 2017-02-13 2027-02-12
Port of Entry: Length of Stay: Visa Type:
MANILA 8 TOURISMLEISURE
Destination after the Philippines: CHINA
Documents submitted in support of application : Passport, Financial Proof, National ID, Air
Ticket
1. Do you have sponsor/reference in the Philippines? If yes fill out below. No

2. Were you ever refused any kind of Philippine visa before and denied admission into or deported from
the Philippines? If yes, state the circumstances. No
3. Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon,
amnesty, or other legal action? If yes, state the circumstances. No
4. Have you ever been afflicted with a communicable disease of public health significance, dangerous
physical or mental disorder, or been a drug abuser or addict? If yes, state the circumstances. No
5. Have you ever served in the military or acted as a Foreign Agent? If yes, state the circumstances.
No
6. Have you previously worked or do you intend to work in the Philippines? If yes, state the
circumstances. No
I understand that I may only enter the Philippines at the Port of Entry designated by the Philippine
Immigration Authorities and under the condition imposed by those authorities. I solemnly swear that the
foregoing statements are true to the best of my knowledge.
REMINDERS:
Applicants must comply with all requirements.
Unruly or rude behavior may result to visa HAINING LI
denial. APPLICANT'S SIGNATURE
Visa is a privilege, not a right. Visa issuance
does not guarantee entry to the Philippines.