BI FORM 2015 08 001 Rev 0 ECC Application Form 1 
BI FORM 2015-08-001 Rev 0
This document may be reproduced and is NOT FOR SALE
EMIGRATION CLEARANCE CERTIFICATE (ECC) APPLICATION FORM
ECC/SRC No.___________________________________
Attach your 2x2 colored photograph with white background using permanent glue in the photograph box.
I.
APPLICATION INFORMATION
The photograph must be taken within the last three (3) months from the date of application.
A scanned photograph is not allowed. A photograph of the applicant wearing eyewear (i.e. sunglasses, colored contact lenses, etc.) or headwear is not acceptable.
RE-ENTRY PERMIT
SPECIAL RETURN CERTIFICATE
CERTIFICATE OF EXEMPTION
(A separate form must be submitted for each application.)
The Honorable
BUREAU OF IMMIGRATION
Manila
Sir:
The undersigned alien hereby makes this sworn application for Re-entry Permit/Special Return Certificate/ Certificate of Exemption/Clearance
Certificate here from, provided for under Section 22 and Section 22-A of the Philippine Immigration Act of 1940, as amended, or Administrative Order dated 04 June 1954, and the rules and regulations issued and submits the following information in support thereof.
II. APPLICANT’S PERSONAL INFORMATION
Last Name
First/Given Name
Middle Name
Residential Address in the Philippines
House/Unit No., Street, Subdivision
Barangay, Municipality/City
Province, Zip Code
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]
Gender
M
Marital Status
Citizenship/Nationality
F
Country of Birth
Single
Annulled
Widowed
Married
Separated
Divorced
If married, widowed, or divorced, give the name and address of present or former spouse:
Name of Spouse [Last Name, First/Given Name, Middle Name]
Address of Spouse
III. APPLICANT’S TRAVEL INFORMATION
Applicant’s Status of Latest Admission in the Philippines
Date of Latest Admission in the Philippines
[DD-MMM-YYYY e.g. 01 JAN 1990]
Reason for Leaving: ________________________________________________________________________________________________________
This document may be reproduced and is NOT FOR SALE
EMIGRATION CLEARANCE CERTIFICATE (ECC) APPLICATION FORM
ECC/SRC No.___________________________________
Attach your 2x2 colored photograph with white background using permanent glue in the photograph box.
I.
APPLICATION INFORMATION
The photograph must be taken within the last three (3) months from the date of application.
A scanned photograph is not allowed. A photograph of the applicant wearing eyewear (i.e. sunglasses, colored contact lenses, etc.) or headwear is not acceptable.
RE-ENTRY PERMIT
SPECIAL RETURN CERTIFICATE
CERTIFICATE OF EXEMPTION
(A separate form must be submitted for each application.)
The Honorable
BUREAU OF IMMIGRATION
Manila
Sir:
The undersigned alien hereby makes this sworn application for Re-entry Permit/Special Return Certificate/ Certificate of Exemption/Clearance
Certificate here from, provided for under Section 22 and Section 22-A of the Philippine Immigration Act of 1940, as amended, or Administrative Order dated 04 June 1954, and the rules and regulations issued and submits the following information in support thereof.
II. APPLICANT’S PERSONAL INFORMATION
Last Name
First/Given Name
Middle Name
Residential Address in the Philippines
House/Unit No., Street, Subdivision
Barangay, Municipality/City
Province, Zip Code
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]
Gender
M
Marital Status
Citizenship/Nationality
F
Country of Birth
Single
Annulled
Widowed
Married
Separated
Divorced
If married, widowed, or divorced, give the name and address of present or former spouse:
Name of Spouse [Last Name, First/Given Name, Middle Name]
Address of Spouse
III. APPLICANT’S TRAVEL INFORMATION
Applicant’s Status of Latest Admission in the Philippines
Date of Latest Admission in the Philippines
[DD-MMM-YYYY e.g. 01 JAN 1990]
Reason for Leaving: ________________________________________________________________________________________________________