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SRRV Application for Principal
PRA application form for special resident retiree visa
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: SPECIAL RESIDENT RETIREE’S VISA APPLICATION
(ENGLISH)
PHILIPPINE RETIREMENT AUTHORITY
29F Citibank Tower, Paseo de Roxas, Makati City, 1227 Philippines
Tel No. +632-848-1412, +632-848-1418; Fax No. +632-848-1411
E-mail: inquiry@pra.gov.ph; Website: pra.gov.ph
Attach 2” x 2” colored
photo taken not more
than 6 months ago
APPLICATION FORM FOR PRINCIPAL RETIREE (Entries must be typewritten)
SRRV Options (Please Check √)
□SMILE
Application No.
□Classic
□Human Touch
Last Name
Gender
□ Male
□ Female
Civil Status
□Single
□Courtesy
First Name
Date of Birth
Alias (AKA)
Place of Birth
Religion
Nationality
ID No.
□ Divorced
□Married
Passport No.
□ Widowed
Place of Issue
Height
Date of Issue
Weight
Valid Until
Home Country Address (Please specify)
Telephone No.
Fax No.
Mobile No.
E-mail
Mobile No.
E-mail
Primary Address in the Philippines
(Please specify)
Secondary Address in the Philippines
Primary
(Please specify)
Telephone No.
Fax No.
Family Member Information
Name of Spouse:
Date of Birth
Age
ID No. (Required)
Included in your application?
□Yes □No
Name of Child ：
Date of Birth
Age
ID No. (Required)
Included in your application?
□Yes □No
Name of Child ：
Date of Birth
Age
ID No. (Required)
Included in your application?
□Yes □No
Name of Child ：
Date of Birth
Age
ID No. (Required)
Included in your application?
□Yes □No
Name of Child ：
Date of Birth
Age
ID No. (Required)
Included in your application?
□Yes □No
( if necessary, use additional sheet )
PRA-CR-FORM-0004
ISSUE NO: 0002
ISSUE DATE: NOVEMBER 2018
Parent’s Information
Name of Father
Name of Mother
Age
Age
Contact No.
Name of Contact Person in
Case of
Nationality
Relationship
Address
Date of Arrival in the Philippines
Expiration Date of Tourist
Entry Visa to the Philippines
Visa / Others
□
Have you visited Philippines prior to this travel?
Yes
□
No
If the answer is “Yes”, What kind of entry visa?
□
□
Tourist Visa
Missionary Visa
□
□
□ Investment Visa
□ Others (Please specify)
Working Visa
Student Visa
Last three years residence
Period of stay (mm/yyyy - mm/yyyy)
Address
1
2
3
4
Educational Attainment
School and Location
From/To (mm/yyyy - mm/yyyy)
1
2
3
Name and Address of Present Company / Business (ifany):
Contact No.
Aside from retirement, what are the other plans/future actions in the Philippines
□ Tourism/Travel
□ Investment
□ Employment
□ Others (Please specify)
Employment in the last three (3) years.
Company Name and Address
Job Title
From/To (mm/yyyy~mm/yyyy)
1
2
3
PRA-CR-FORM-0004
ISSUE NO: 0002
ISSUE DATE: NOVEMBER 2018
Please read carefully:
The following classes of aliens, shall be excluded from entry into the Philippines, and are not eligible to acquire a Special
Resident Retiree’s Visa:
1.
Insane persons, persons afflicted with a contagious disease, persons with manifestation of any anxiety, depressive,
psychotic, personality and psychological disorders identified and observed during the conduct of medical
examination as certified by the person’s attending physician.
Pauper, vagrant, and beggars, persons who are likely to become a public charge, stowaways, persons who have
been excluded or deported from the Philippines, including those deported as indigent aliens, or persons not properly
documented for admission;
Persons who have been convicted of a crime involving moral turpitude, prostitutes or procures, persons coming for
any immoral purposes;
Persons who believe in, or advocate the overthrow by force and violence of the Government of the Philippines, or of
constituted lawful authority, or who disbelieve in, or are opposed to an organized government, and people who use
force and violence in pursuit of their advocacies;
Persons over fifteen (15) years of age, physically capable of reading, who cannot read printed matter in ordinary use
in any language selected by the alien, persons who are members of a family accompanying an excluded alien; or
Persons coming to perform unskilled manual labor in pursuit of a promise or offer of employment.
2.
3.
4.
5.
6.
The mere act of submitting this form, for the purpose of processing the application, is an affirmation that the applicant is
not excluded nor a disqualified person based on existing Philippine Immigration laws.
By affixing my signature, I hereby certify that all the
information above are true and correct, and that any
misrepresentation on my part shall be ground for the denial
of my SRRV application and/or revocation of my current
Visa:
Accredited Marketer (if any):
Registered Name of Marketer:
PRA Accreditation No:
Date Signed :
Telephone No:
(To be accomplished by PRA Personnel)
-------------------------------------------------------------------------------------------------------------------------------------------------------
Date of Receipt of Application Form :
Papers Reviewed & Certified Complete by: (Please indicate complete name, designation, and long-form signature)
Comments / Remarks:
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(To be accomplished upon issuance of SRRV)
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------SRRV Number:
Date of Issuance:
Date of Oath-taking:
PRA-CR-FORM-0004
ISSUE NO: 0002
ISSUE DATE: NOVEMBER 2018
FOR MARKETING RESEARCH PURPOSES
1
How did you learn about SRRV?
PRA Office / Officers
Newspaper
PRA Website
TV
Other Websites
Friends, Families, associates
2
PRA Newsletters
Magazine
Marketers
Have you visited the Philippines prior to joining The PRA Program?
Yes
No
If Yes, how many times?
On the average how long did you stay?
3
When was the last time you visited?
Where did you stay?
Which part of the Philippines do you particularly plan to stay longer?
Baguio
Subic
Cebu
4
Clark
Metro Manila
Davao
Others Please specify :
Tagaytay
I would like to receive updates / news about PRA and its partners, thru the following:
By Phone
Phone No.:
By Email
Email Address:
By Post
Postal Address:
PRA-CR-FORM-0004
ISSUE NO: 0002
ISSUE DATE: NOVEMBER 2018
