フィリピン出国カード ２００５年５月

Republic of the Philippines

BUREAU OF IMMIGRATION

 EMBARKATION CARD

(For Departing Passengers)
　
SURNAME/FAMILY NAME FIRST NAME MIDDLE NAME

○○○○○○ ○○○○○○
1 ■MALES

2 □FEMALE

 BIRTHDAY(MM/DD/YY)

月/日/年（西暦）

 COUNTRY OF BIRTH

JAPAN
CITIZENSHIP

JAPANESE

 OCCUPATION

OFFICE CLERK
ADDRESS ABROAD (NO, STREET, TOWN/CITY, STATE/COUNTRY, ZIP CODE)

○○○○○○○○○, SENDAI-SHI.,JAPAN 981-0904
ADDRESS IN THE PHILIPPINES (NO, STREET, TOWN/CITY, PROVINCE)

○○○○○○○○, MAYONG KANKURAN, Q.C. M.M
PASSPORT NUMBER

○○○○○○○○○

 PLACE OF ISSUE

JAPAN

DATE OF ISSUE(MM/DD/YY)

月/日/年（西暦）
MAIN PURPOSE OF TRAVEL (CHECK APPROPRIATE BOX)

1 ■HOLIDAY/PLEASURE 3 □CONVENTION 5 □OTHERS

2 □VISIT FRIENDS/RELATIVES 4 □BUSINESS (SPECIFY)

NUMBER OF VISITS TO THE PHILIPPINES

□ 1 □ 2 ■ 3 or more

 TRAVELING ON PACKAGE TOUR

1 ■ YES 2 □ NO
SIGNATURE OF PASSENGER

○○○○○ ○○○○○○

 AIRPORT OF ORIGIN

MANILA

 FRIGHT NO.

NW28
FOR PHILIPPINE OVERSEAS CONTRACT WORKERS/BALIKBAYAN USE ONLY
OCW ID. NO.

　

　

 REASONS FOR RETURNING.TO RP

1 □ CONTRACT TERMINATED

2 □ VACATION/ON LEAVE

3 □ HEALTH

4 □ OTHERS (SPECIFY)
DATE OF LAST DEPARTURE

(MM/DD/YY)
DEATH TO DRUG TRAFFICKERS

WARNING:

UNDER PHILIPPIN LAW (RA 7659)