Application Form For PEZA Visa

LAG.2.F.
004
Rev. 00: Nov. 29, 2021
Republic of the Philippines

PHILIPPINE ECONOMIC ZONE AUTHORITY
DoubleDragon Center West Building
DD Meridian Park, Macapagal Avenue, Pasay City
Trunk Line No.: (632) 8551-3451 Loc. 111/112/117 | Direct Line No.: (632) 8551-3427 | E-mail Add:
[email protected]
APPLICATION FOR PEZA VISA (PV)

The undersigned hereby requests for issuance of a PEZA Visa (PV) with special multiple entry
privileges and with exemptions from exit clearances certificates, re-entry permits and special
return certificates, pursuant to Memorandum of Agreement between Philippine Economic Zone
Authority (PEZA) and Bureau of Immigration (BI), and in support thereof submits the following
information and representation.
FIRST NAME MIDDLE NAME LAST NAME
Age: _________ Sex: _________ Date of Birth: ___________ Place of Birth: ______________
Nationality _______________ Civil Status (Single, Married, Divorced, etc.): _____________
Passport No. ________________________ Issued at: ______________________________
Issued on: ________________________ Valid until: _____________________________
Philippine Residential Address:____________________________________________________

Telephone: ______________
Employing PEZA-registered enterprise: _____________________________________________

Enterprise Address: _____________________________________________________________
Position: ______________________ Tel No.: __________ E-mail Address: _______________
Date of Arrival and Length of Stay (for new application): _________________________________

Educational Background, Training and Experience: ____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
DEPENDENTS ACCOMPANYING THE PRINCIPAL IN THE PHILIPPINES

Name Age Sex Nationality
Spouse ___________________________ _______ ______ ______________

Children ___________________________ _______ ______ ______________
UNDERTAKING OF PEZA REGISTERED ENTERPRISE:
a) Within five (5) working days from termination or cessation of employment for whatever cause,
the PEZA-registered enterprise shall inform PEZA in writing of such termination or cessation of
employment and when applicable, within the same period, shall surrender the work permit and/or
ACR I-Card.
b) PEZA-registered enterprise shall likewise assume responsibility for the voluntary departure
and cancellation of PEZA visa of said Foreign National upon termination of employment/training.
DOCUMENTARY REQUIREMENTS:
• PEZA ZA/ZM Endorsement to the Director General

• Copy of PEZA Official Receipt issued for payment of the Processing Fee duly certified as
true copy by the PEZA Cashier or the assigned Special Collecting Officer of PEZA in the
ecozone, and indicating therein the name of the foreign national and his/her qualified
dependents, if applicable
• Checklist of application for PV Extension or for Change of Admission.
• Certified True Copy of PEZA Certificate of Registration.
• Photocopy of passport of the foreign national (Bio page, Pages containing date of latest
arrival and the valid/expiring/updated visa) with validity of not less than six (6) months
from time of application.
• Notarized Certificate of Employment or Contract of Employment, indicating the period of
employment.
• Notarized Certification signed by the President or Chief Executive Officer or duly
authorized official stating (1) the number of foreign nationals employed vis-à-vis Filipino
employees; and (2) the current percentage of employed foreign nationals over the total
work force.
• Certified True Copy of the foreign national’s Alien Employment Permit (AEP), or proof of
application of AEP duly received by DOLE Office and the corresponding Official Receipt
bearing the name of the foreign national and the enterprise or Certificate of Exclusion
issued by DOLE.
• Comprehensive Bio-data/Resume/Curriculum Vitae duly signed by the applicant.
• Understudy with Undertaking for technical and supervisory positions.
• Organizational chart of the enterprise.
• Birth certificate (children)/marriage certificate (spouse) with English translation and
Philippine embassy/consulate authentication from Applicant’s country of origin OR with
Apostille OR PSA-issued marriage/birth certificate.
• Notarized Affidavit of Support/Guarantee, executed by the PEZA-registered company’s
President/Vice-President.
Done in the City/Province of _________________Philippines, this ___________ Day of

______________, 2021.
_________________
(Signature)
REPUBLIC OF THE PHILIPPINES)

CITY/PROVINCE OF __________) S.S.
SUBSCRIBED AND SWORN to me before me this ___________ day of ____________,
2021, in the City/Province of ____________, affiant exhibited to me his/her ACR or Passport No.
_____________ issued at _______________ on _____________________, 2021.
____________________
NOTARY PUBLIC
Until December 31, 2021
Doc. No. __________;
Page No.__________;
Book No.__________;
Series of 2021______;

Application Form For PEZA Visa

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LAG.2.F.

Republic of the Philippines

APPLICATION FOR PEZA VISA (PV)

FIRST NAME MIDDLE NAME LAST NAME

Philippine Residential Address:____________________________________________________

Employing PEZA-registered enterprise: _____________________________________________

Date of Arrival and Length of Stay (for new application): _________________________________

DEPENDENTS ACCOMPANYING THE PRINCIPAL IN THE PHILIPPINES

Spouse _______________________ _ __________

• PEZA ZA/ZM Endorsement to the Director General

Done in the City/Province of _______Philippines, this _ Day of

REPUBLIC OF THE PHILIPPINES)

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