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2014-03-006 Rev 0 Accreditation Application Form for Liaison Officers and Representatives
BI application form for liaison officers and representatives accreditation
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This document may be reproduced and is NOT FOR SALE
BI ACCREDITATION APPLICATION FORM
FOR LIAISON OFFICERS AND REPRESENTATIVES
Attach your 2x2 colored photograph
with white background using
permanent glue in the
photograph box.
The photograph must be taken
within the last three (3) months
from the date of application.
A scanned photograph is not
allowed. A photograph of the
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses,
etc.) or headwear is not acceptable.
REMINDERS:
1. Accomplish this form by writing as legibly & comprehensively as possible.
2. Check the corresponding box of your answer, if applicable.
3. Submit 2 pieces of 2x2 colored photograph. Paste one photograph on the
corresponding space and submit the other one to the concerned frontline officer.
4. Please comply with the requirements to avoid delay in issuing your
accreditation.
5. Any changes in the provided information without informing the Bureau will be
ground for denial or cancellation of the accreditation.
(INFORMATION PROVIDED WILL BE THE BASIS FOR ID PRINTING.)
APPLICATION CATEGORY
Law Office
Consultancy Office/Corporation
Travel Agency
Consular Office or Government Organization
Missionary
BONDS
Cash Bond O.R. No.
Surety Bond O.R No.
N/A
I. APPLICATION
Nature of Application
New Applicant
Renewal
II. APPLICANT’S PERSONAL INFORMATION
Last Name
First/Given Name
Middle Name
Other Name(s)/Alias(es)
1
2
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]
Gender
M
Height [cm]
Weight [kg]
Civil Status
F
Single
Married
Annulled
Separated
Widowed
Divorced
Citizenship/Nationality
Social Security System (SSS) Number
PhilHealth Number
Government Service Insurance System (GSIS) Number
Tax Identification Number (TIN)
Company/ Agency Employee Number
Residential Address in the Philippines
House/Unit No., Street, Subdivision/Village
Contact Number(s) in the Philippines
Landline
Barangay, Municipality/City
Mobile
Province, Zip Code
Email Address
III. EMPLOYMENT
Name of Office
Designation
Office Address
Room No., Floor No., Building, Street
Contact Number(s) in the Philippines
Landline
Barangay, Municipality/City
Mobile
Province, Zip Code
Facsimile
Email Address
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BI FORM 2014-03-006 Rev 0
This document may be reproduced and is NOT FOR SALE
BI ACCREDITATION APPLICATION FORM
FOR LIAISON OFFICERS AND REPRESENTATIVES
1.
Immigration-related Seminars Attended
Title of Seminar
Batch No.
2.
Date of Seminar [DD-MMM-YYYY e.g. 01 JAN 1990]
Title of Seminar
Batch No.
3.
Date of Seminar [DD-MMM-YYYY e.g. 01 JAN 1990]
Title of Seminar
Batch No.
Date of Seminar [DD-MMM-YYYY e.g. 01 JAN 1990]
IV. EMPLOYMENT HISTORY
1.
Organization
Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000 – 20 JUL 2013]
2.
Organization
Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000 – 20 JUL 2013]
3.
Organization
Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000 – 20 JUL 2013]
4.
Organization
Inclusive Dates [DD-MMM-YYYY e.g. 01 MAR 2000 – 20 JUL 2013]
V. Have you ever been issued a Ban Order/Cancellation Order in violation of BI Accreditation guidelines or regulations?
YES
NO
If YES, give details: _________________________________________________________________________________________________________
[Violation]
[Date of Order]
[Ban/Cancellation Order Number]
Was your Ban Order lifted? Give details: ________________________________________________________________________________________
[Date of Order]
[Lifting Ban Order Number]
I declare that this BI Accreditation Application Form has been accomplished by me, and is true, correct and
complete pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
I also authorized the agency head/authorized representative to verify/validate the contents stated herein. I
trust that information shall remain confidential.
________________________________
Date [DD-MMM-YYYY e.g. 01 JAN 1990]
_________________________________
Applicant’s Signature over Printed Name
Name of Office: _______________________________________________________________________________________
________________________________________________________________________________
Received By: _________________________________________________________________________________________
Reviewed By: ________________________________________________________________________________________
Approved By: ________________________________________________________________________________________
Remarks By: _________________________________________________________________________________________
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