VCU Form 3

THIS FORM IS NOT FOR SALE, REPRODUCTION IS ALLOWED Jan. 2007

CERTIFICATION REQUEST FOR TRAVEL RECORDS

Date : __________, 20____ (Please Print your Answer)

DATE / TIME
NOTE :
The Passenger Manifest of Arrival/Departure (below 1993) proceed to Records Section (3rd Floor, Room 301).

THE COMMISSIONER INTRAMUROS, MANILA

RECEIVED
VCU window

BUREAU OF IMMIGRATION
Dear Commissioner ;

______________

May I request for a certification for travel records of subject :

SURNAME FIRSTNAME MIDDLE NAME OTHER NAME

Please Check the approximate box :

EMBASSY PURPOSES _____________________________________________________ ( write embassy ) COURT/LEGAL PURPOSES _____________________________________________________ ( filing court / branch / contact # )

FOUNDATIONS
(please check the box)

GREENLIFE

PHIL.JAPAN

TECO

STEP

OTHERS ____________________

OTHER INFORMATION
SEX (please check one) DATE OF BIRTH PLACE OF BIRTH NATIONALITY
Month M F Day Year

PHILIPPINE ADDRESS

PASSPORT NO. TEL. NO./CELL NO. ARRIVAL DATE FLIGHT NUMBER DEPARTURE DATE FLIGHT NUMBER

Very truly yours,

DO NOT FILL THIS PORTION (FOR EMPLOYEES ONLY)

NO RECORD ON FILE
SIGNATURE of Requesting Party
ARRIVAL [for COMPUTER SECTION-VCU only] : FROM: _________________________ TO: __________________________ DEPARTURE : FROM : __________________________ TO: ___________________________
Verified by : _________________ Date / Time : ________________

NOTE
[for RECORDS SECTION only]

PRINTED NAME of Requesting Party

NOTE : Please see BACK PAGE for LIST OF DOCUMENTARY REQUIREMENTS for submission.
VCU Form 3
Bureau of Immigration Verification & Certification Unit

DATE / TIME FILED:

CLAIM STUB for travel cert.

Name of Subject : ___________________________________________________________ Date of Birth : __________________

DATE / TIME released :

Nationality : __________________________
2 to 3 hours processing upon payment depending on the volume of application Always present this receipt upon claiming your certificate Unclaimed certificate shall be automatically cancelled after 30 days from the date of issuance If not the claimant of certificate, present any valid ID Cards

FRONT PAGE

SPECIFIC REQUIREMENTs :
EMBASSY PURPOSES :
Attached xerox copy of PASSPORT (Optional) one xerox valid ID

COURT /LEGAL PURPOSES :

Attached LETTER REQUEST from requesting office & one xerox valid ID

FOUNDATIONS :
Attached xerox copy of passport (optional) one xerox valid ID

CERTIFICATION FEES :
Certification Legal Research Express Fee 500.00 10.00 500.00

TOTAL

Ph P 1,010.00

Collected under C.A. No. 613, Section 42(A)(19) With MEMORANDUM ORDER NO. 02-045 dated 26 September 2002

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