Visa Application Form To Enter Japan: Single
Visa Application Form To Enter Japan: Single
Visa Application Form To Enter Japan: Single
45mm ×45mm
*Official use only
or 2in×2in
Date of birth 08/12/1990 Place of birth San Jose City, Nueva Ecija
(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 N01-12-008463
Passport type: Diplomatic Official Ordinary Other
Passport No. P2725882B
Place of issue NCR East SM Megamall Date of issue 06/08/2019
(Day)/(Month)/(Year)
Issuing authority DFA NCR EAST Date of expiry 06/08/2029
(Day)/(Month)/(Year)
Purpose of visit to Japan WORK
Intended length of stay in Japan 3 years
Date of arrival in Japan May 10, 2023
Ninoy Aquino
Port of entry into Japan International Airport Name of ship or airline Jetstar
Names and addresses of hotels or persons with whom applicant intends to stay
Name 69735923072 Tel. 03-6279-2728
Shimmeicho, Chiba-shi Chuo-ku, Chiba
Address
Dates and duration of previous stays in Japan
Your current residential address (if you have more than one address, please list them all)
N/A
Address
Tel. N/A Mobile No. N/A
Current profession or occupation and position Freelancer
Name and address of employer
Guarantor or reference in Japan(Please provide details of the guarantor or the person to be visited in Japan)
Name Tel.
Address
Date of birth Sex: Male Female
(Day)/(Month)/(Year)
Relationship to applicant
Profession or occupation and position
Nationality and immigration status
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.”