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2015-08-001A Rev 0 ECC 001A Certificate

BI 001A emigration clearance certificate

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Republic of the Philippines
Department of Justice
BUREAU OF IMMIGRATION
Magallanes Drive, Intramuros
1002 Manila

EMIGRATION CLEARANCE CERTIFICATE
No. ______________
This is to certify that
(Last Name,
First Name,
Middle Name)
,
(Age)
(Gender)
(Citizenship/Nationality)
_______, __________, _____________________________, whose photograph,
signature and thumbprints appear below, about to depart from the Philippines for
TEMPORARY/PERMANENT residence abroad is hereby issued this certificate in
accordance with the provision of Section 22(a) of the Philippine Immigration Act of
1940, as amended, allowing his/her departure from this country on or before
___________________________.
Date [Day-Month-Year e.g 01 January 1990]

Manila, Philippines, __________________________.
Date [Day-Month-Year e.g 01 January 1990]

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.

____________________
Signature of Applicant

Left
Thumbmark
Note:

Right
Thumbmark

FOR THE COMMISSIONER
BY:
_______________________________________
Alien Registration Chief

Date and status of latest admission:
______________________________
Expiry of authorized stay:
______________________________
IC No. ________________________

Official Receipt No._______________
Date __________________________
ACR No. _______________________
ICR No. _______________________
CRTV/CRPE No. _________________

At the time of departure, this certificate must be surrendered to the Immigration
Officer at the Port of Departure.
 
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