US VISA APPLICATION

FOR VISA SECTION USE ONLY: ENCODED BY: VESSEL ASSIGNMENT:________________________

DS 160 NO.:
VESSEL: CHECKED AND SUBMITTED BY: VESSEL IMO NO.:_____________________________
DATE OF ARRIVAL:
INTENDED DATE OF ARRIVAL TO U.S.: _______dd _______ mm _______yyyy

DATE HIRED: OCTOBER 28, 2019 DATE REPORTED: MARCH 22, 2022
FLEET MANAGER: NAME & SIGN: CRISTINA B. YUSON POSITION: MESSMAN
FLEET: CMA-CGM SIGN OFF: MARCH 18, 2022

PASSPORT NO.: P9662751B LOST A PASSPORT? YES NO

ISSUE DATE: APRIL 19, 2022 REASON:
EXPIRY DATE: APRIL 18, 2032

SIRB NO.: C1462262 EXPIRY DATE: SEPTEMBER 18, 2028

FULL NAME: OLITA , ALEXANDER MARKINES

LAST NAME FIRST NAME MIDDLE NAME

BIRTHDATE: 10 07 1992 PLACE OF BIRTH: MACROHON, SOUTHERN LEYTE

dd mm yyyy

GENDER: M AGE: 29 NATIONALITY: FILIPINO

CIVIL STATUS: MARRIED CELLPHONE NO.: 09276795855

HOME ADDRESS: S. BANTUG ST., TUNGA-TUNGA, MAASIN CITY, SOUTHERN LEYTE ZIP CODE: 6600

SPOUSE MULAAN , LYN ORAG

MAIDEN NAME: LAST NAME FIRST NAME MIDDLE NAME

BIRTHDATE: 04 08 1989 PLACE OF BIRTH: MAASIN, SOUTHERN LEYTE

dd mm yyyy NATIONALITY: FILIPINO

HAVE YOU EVER BEEN IN THE US: YES NO

IF YES, WHEN?
23 ''$$$$
!" ##$$$$ 03 ))$$$$
2016 4 days
!"# $"%&' ((((((((
12 yy____
28 mm____
2. dd____ 2017 3 days
!"# $"%&' ((((((((
14 mm____
3. dd____ 2019
04 yy____ 3 days
!"# $"%&' ((((((((
4. dd____ mm____ yy____ !"# $"%&' ((((((((
5. dd____ mm____ yy____ !"# $"%&' ((((((((

DO YOU HAVE PREVIOUS VISA? YES NO IF YES: C1/D

TYPE: ___________
DATE OF ISSUE: APRIL 7, 2015
HAVE YOU EVER BEEN DENIED?: YES NO
IF YES: REASON? WHEN?
dd mm yyyy

FATHER'S NAME: JARABE , EXEQUIEL DELPIN

LAST NAME FIRST NAME MIDDLE NAME

BIRTHDATE: 10 04 1927 IS YOUR FATHER IN THE U.S.? YES NO

dd mm yyyy IF YES, STATUS? ___CITIZEN __ LEGAL RESIDENT ___NON-IMMIGRANT ___WORKING

MOTHER'S OLITA , ESMERALDA MARKINES

MAIDEN NAME: LAST NAME FIRST NAME MIDDLE NAME

BIRTHDATE: 29 09 1957 IS YOUR MOTHER IN THE U.S.? YES NO

dd mm yyyy IF YES, STATUS? ___CITIZEN __ LEGAL RESIDENT ___NON-IMMIGRANT ___WORKING

DO YOU HAVE ANY RELATIVE IN THE US? YES NO

IF YES, NAME:
RELATIONSHIP:
STATUS OF RESIDENCY:

DIFFERENT COUNTRIES YOU HAVE VISITED IN THE LAST 5 YEARS: (not included U.S.A.)
FRANCE
1.) ___________________________ SPAIN
6.) ___________________________
BELGIUM
2.) ___________________________ SINGAPORE
7.) ___________________________
ROTTERDAM
3.) ___________________________ SOUTH KOREA
8.) ___________________________
4.) ___________________________
GERMANY 9.) ___________________________
HONG KONG
LONDON
5.) ___________________________ MALAYSIA
10.) ___________________________

LAST EMPLOYER BEFORE DIVERSIFIED:

SOUTHFIELD :
COMPANY: SOUTHFIELD AGENCIES, INC. RANK: MESSMAN
STARTED: 18 03 2014 UNTIL: 06 12 2018
dd mm yyyy dd mm yyyy

ADDRESS: 2115 MADRE IGNACIA ST., MALATE, MANILA SUPERVISOR: CAPT. SONNY D. VALENCIA

CONTACT NO.: _________________________

(632) 304-1888
EDUCATIONAL ATTAINMENT
557 MAGSAYSAY ST., SIBULAN,
HIGH SCHOOL: SIBULAN NATIONAL HIGH SCHOOL ADDRESS: NEGROS ORIENTAL
INCLUDE STREET NAME
STARTED: 03 06 2004 UNTIL: 31 03 2008 ZIP CODE:__________________
6201
dd mm yyyy dd mm yyyy

CAPITOL AREA, KAGAWASAN AVE., DUMAGUTE,

COLLEGE: NEGROS ORIENTAL STATE UNIVERSITY ADDRESS: NEGROS, ORIENTAL
INCLUDE STREET NAME
STARTED: 03 06 2008 UNTIL: 31 03 2009 ZIP CODE:__________________
6200
dd mm yyyy dd mm yyyy

COURSE: BACHELOR OF SCIENCE IN MARINE TRANSPORTATION

TECHNICAL SCHOOL: ASIAN INSTITUTE OF CULINARY ARTS ADDRESS:

INCLUDE STREET NAME #68 SEN. GIL PUYAL AVE.,MAKATI CITY
STARTED: 11 06 2013 UNTIL: 06 12 2013 ZIP CODE:__________________
1224
dd mm yyyy dd mm yyyy

COURSE: COMPREHENSIVE CULINARY ARTS PROGRAM WITH MENU PLANNING

MEDIA FLATFORM:
FACEBOOK | INSTAGRAM | TIK TOK | TWITTER | YOUTUBE
MEDIA FLATFORM USER I.D.: ALEXANDER MARKINES OLITA

EMAIL ADDRESS: alexanderolita13@gmail.com

MONTHLY INCOME (IN PESO): P60,000.00

BRIEFLY DESCRIBE YOUR DUTIES ONBOARD:

___________________________________________________________________________________
ASSIST CHIEF COOK IN PREPARING MEALS; MAINTAIN CLEANLINESS OF THE GALLEY, COLD ROOMS,
___________________________________________________________________________________
DRY STORE AND MESSROOM.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

REMINDER:

In the authorization letter kindly fill up the blank and put your FULL NAME
and CONTACT NUMBER before you sign.
January 28, 2022

LBC EXPRESS
Ground Floor Ayala Life FGU Center,
#6811 Ayala Avenue, Makati City
1200 Metro Manila

To Whom It May concern:

Good day!

I, __________________________________
ALEXANDER M. OLITA residing at ______________________________
S. BANTUG ST., TUNGA-TUNGA,

___________________________________
MAASIN CITY, SOUTHERN LEYTE hereby authorizes __________________residing
at 19th Floor Salcedo Towers, 169 H.V. Dela Costa St., Salcedo Village, Makati City to pick
up the parcel on my behalf, including the signing of the proof of delivery.

OTHER INFORMATION:
Applicant’s fee receipt number: (kindly see attached)

Sincerely yours,

A.Olita
ALEXANDER M. OLITA