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1application Form

1. The document is a visa application form to enter Japan submitted by Robin Adeline Cuevas Gochangco, a Filipino citizen born in Cebu City, Philippines. 2. Ms. Gochangco is applying for a 4-day leisure visit to Japan arriving on December 28, 2022 at Narita Airport, staying at Hotel Mystays Gotanda in Tokyo. 3. She lists her father, a businessman, and mother, a housewife, and provides contact information for her daughter Joseph Carlo Gochangco who lives in Cebu City, Philippines.

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Joseph Carlo Gochangco
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69 views2 pages

1application Form

1. The document is a visa application form to enter Japan submitted by Robin Adeline Cuevas Gochangco, a Filipino citizen born in Cebu City, Philippines. 2. Ms. Gochangco is applying for a 4-day leisure visit to Japan arriving on December 28, 2022 at Narita Airport, staying at Hotel Mystays Gotanda in Tokyo. 3. She lists her father, a businessman, and mother, a housewife, and provides contact information for her daughter Joseph Carlo Gochangco who lives in Cebu City, Philippines.

Uploaded by

Joseph Carlo Gochangco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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VISA APPLICATION FORM TO ENTER JAPAN

(Paste photo here)

45mm ×35mm
*Official use only
or 2in x 1.4in

Surname (as shown in passport) GOCHANGCO


Given and middle names (as shown in passport) ROBIN ADELINE CUEVAS
Other names (including any other names you are or have been known by)

Date of birth 26/11/20 Place of birth MANDAUE CITY CEBU, PHILIPPINES


(Day)/(Month)/(Year) (City) (State or Province) (Country)
Sex: Male Female Marital status: Single Married Widowed Divorced
Nationality or citizenship PHILIPPINES
Former and/or other nationalities or citizenships
ID No. issued to you by your government P9024156B
Passport type: Diplomatic Official Ordinary Other Passport No. P9024156B
Place of issue DFA CEBU Date of issue 21/02/22
(Day)/(Month)/(Year)
Issuing authority DFA CEBU Date of expiry 20/02/27
(Day)/(Month)/(Year)
Purpose of visit to Japan LEISURE
Intended length of stay in Japan 4
Date of arrival in Japan DECEMBER 28, 2022
Port of entry into Japan NARITA, TOKYO Name of ship or airline PHILIPPINE AIRLINES
Names and addresses of hotels or persons with whom applicant intends to stay
Name HOTEL MYSTAYS GOTANDA Tel. +81 3 3449 4831
SHINAGAWA-KU, HIGASHIGOTANDA 2-5-4, SHINAGAWA WARD, TOKYO, 141-002, JAPAN
Address
Dates and duration of previous stays in Japan 24/08/18 to 29/08/18, 03/04/19 to 07/04/19
Your current residential address (if you have more than one address, please list them all)
18-B PASEO JOHN, MARIA LUISA, BANILAD, CEBU CITY, CEBU, PHILIPPINES
Address
Tel. +63 917 8880012 Mobile No. +63 917 8880012
E-Mail DYANCUEVAS@GMAIL.COM
Current profession or occupation and position CHILD
Name and address of employer

Name Tel.

Address
*Partner's profession/occupation (or that of parents, if applicant is a minor):
BUSINESSMAN (FATHER), HOUSEWIFE (MOTHER)
Guarantor or reference in Japan(Please provide details of the guarantor or the person to be visited in Japan)
Name JOSEPH CARLO GOCHANGCO Tel. +63 918-8888921
18-B PASEO JOHN, MARIA LUISA, BANILAD, CEBU CITY, CEBU, PHILIPPINES
Address
Date of birth 21/09/88 Sex: Male Female
(Day)/(Month)/(Year)
Relationship to applicant DAUGHTER
Profession or occupation and position BUSINESSMAN
Nationality and immigration status FILIPINO CITIZEN
Inviter in Japan(Please write 'same as above' if the inviting person and the guarantor are the same)
Name Tel.

Address
Date of birth Sex: Male Female
(Day)/(Month)/(Year)
Relationship to applicant
Profession or occupation and position
Nationality and immigration status
*Remarks/Special circumstances, if any
Have you ever:
● been convicted of a crime or offence in any country? Yes No
● been sentenced to imprisonment for 1 year or more in any country?** Yes No
● been deported or removed from Japan or any country for overstaying your visa or violating
any law or regulation? Yes No
● been convicted and sentenced for a drug offence in any country in violation of law
concerning narcotics, marijuana, opium, stimulants or psychotropic substances?** Yes No
● engaged in prostitution, or in the intermediation or solicitation of a prostitute for other
persons, or in the provision of a place for prostitution, or any other activity directly
connected to prostitution? Yes No
● committed trafficking in persons or incited or aided another to commit such an offence? Yes No
** Please tick “Yes” if you have received any sentence, even if the sentence was suspended.
If you answered “Yes” to any of the above questions, please provide relevant details.

“I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to
be granted are decided by the Japanese immigration authorities upon my arrival. I understand that possession of a visa does not
entitle the bearer to enter Japan upon arrival at port of entry if he or she is found inadmissible.”
“I hereby consent to the provision of my personal information (by an accredited travel agent, within its capacity of representing
my visa application) to the Japanese embassy/consulate-general and (entrust the agent with) the payment of my visa fee to the
Japanese embassy/consulate-general, when such payment is necessary.”

Date of application 02/12/22 Signature of applicant


(Day)/(Month)/(Year)
* It is not mandatory to complete these items.
Any personal information filled in this application as well as additional information submitted for the visa application (hereinafter
referred to as "Retained Personal Information”) will be handled appropriately in accordance with the Act on the Protection of
Personal Information Held by Administrative Organs (Act No. 58 of 2003, hereinafter, “the Act”). Retained Personal Information
will only be used to the extent necessary for the purpose of processing the visa application (including providing personal
information to the transportation company which you intend to board, or the alternative airline or ship which you initially did not
intend to board due to unforeseen circumstances) and for other purposes in compliance with Article 8 of the Act.

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