VCU Form 3

THIS FORM IS NOT FOR SALE,

REPRODUCTION IS ALLOWED
Jan. 2007

CERTIFICATION REQUEST FOR TRAVEL RECORDS

(Please Print your Answer)
Date : __________, 20____
DATE / TIME
THE COMMISSIONER
NOTE : RECEIVED
VCU window
BUREAU OF IMMIGRATION The Passenger Manifest of Arrival/Departure
INTRAMUROS, MANILA (below 1993) proceed to Records Section (3rd Floor,
Room 301). ______________
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 COURT/LEGAL PURPOSES

_____________________________________________________ _____________________________________________________
( write embassy ) ( filing court / branch / contact # )

FOUNDATIONS
(please check the box) GREENLIFE PHIL.JAPAN TECO STEP OTHERS
____________________

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

PASSPORT NO.
TEL. NO./CELL NO.

ARRIVAL DATE FLIGHT NUMBER DEPARTURE DATE FLIGHT NUMBER

DO NOT FILL THIS PORTION (FOR EMPLOYEES ONLY)

Very truly yours,
NO RECORD ON FILE NOTE
[for COMPUTER SECTION-VCU only] [for RECORDS SECTION only]
SIGNATURE of Requesting Party
ARRIVAL : FROM: _________________________

TO: __________________________
PRINTED NAME of Requesting Party
DEPARTURE : FROM : __________________________

TO: ___________________________

Verified by : _________________ Date / Time : ________________

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. DATE / TIME released : [

Name of Subject : ___________________________________________________________

Date of Birth : __________________ 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 500.00
Legal Research 10.00
Express Fee 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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