VISA APPLICATION FORM TO ENTER
JAPAN
Surname (as shown in passport) ESPIRITU
Given and middle names (as shown in passport) MICHAEL
Other names (including any other names you are or have been known by)
N/A
Date of birth 09/10/1984 Place of birth CASTILLEJOS ZAMBALES PHILIPPINES
(Day)/(Month)/(Year)
(City) (State or Province) (Country)
Sex: Male
Female
Marital status: Single Married Widowed Divorced
Nationality or citizenship FILIPINO
Former and/or other nationalities or citizenships
N/A
ID No. issued to you by your government P0857942B
Passport type: Diplomatic Official Ordinary Other Passport No. P0857942B
Place of issue DFA PAMPANGA
Issuing authority DFA PAMPANGA
Date of issue 02/28/2019
(Day)/(Month)/(Year)
Date of expiry 27/02/2029
(Day)/(Month)/(Year)
Certificate of Eligibility No. _23-001247________________________________________________
Purpose of visit to Japan SPECIFIED SKILLED WORKER I
Intended length of stay in Japan 1 YEAR Date of arrival in Japan 9/20/2023
Port of entry into Japan IMABARI Name of ship or airline PHILIPPINE AIRLINES
Names and addresses of hotels or persons with whom applicant intends to stay
Name MR. HASHIDA SHOJI Tel. 09062820817
Address 783-5 YAMAJI EHIME PREFECTURE IMABARI-SHI 794-0072
Dates and duration of previous stays in Japan N/A
Your current residential address (if you have more than one address, please list them all)
Address BALAYBAY RESETTLEMENT CASTILLEJOS ZAMBALES
Tel. N/A Mobile No.09683079211
Email:
[email protected]Current profession or occupation and position N/A
Name and address of employer
Name N/A Tel. N/A
Address N/A
*Partner's profession/occupation (or that of parents, if applicant is a minor):
N/A
Guarantor or reference in Japan(Please provide details of the guarantor or the person to be visited in Japan)
Name HASHIDA SHOJI Tel. 09062820817
783-5 YAMAJI EHIME PREFECTURE IMABARI-SHI 794-0072
Address
Date of birth 23/12/1948
(Day)/(Month)/(Year)
Sex: Male
Female
Relationship to applicant N/A Profession or occupation and position GENERAL
SECRETARY/REPRESENTATIVE Nationality
Inviter in Japan(Please write 'same as above' if the inviting person and the guarantor are the same)
Name HASHIDA SHOJI Tel. 09062820817
783-5 YAMAJI EHIME PREFECTURE IMABARI-SHI 794-0072
Address
Date of birth 23/12/1948
(Day)/(Month)/(Year)
Sex: Male
Female
Relationship to applicant N/A Profession or occupation and position GENERAL SECRETARY/
REPRESENTATIVE Nationality
*Remarks/Special circumstances, if any N/A
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?**
• been deported or removed from Japan or any country for overstaying your visa or violating any law or
regulation?
• been convicted and sentenced for a drug offence in any country in violation of law concerning
narcotics, marijuana, opium, stimulants or psychotropic substances?**
• 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?
• committed trafficking in persons or incited or aided another to commit such an offence?
** 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.
Yes No
Yes No
Yes No
Yes No
Yes No
“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.”
Date of application 11/9/2023
(Day)/(Month)/(Year)
* It is not mandatory to complete these items.
Signature of applicant
Any personal information gathered in this application as well as additional information submitted for the visa application
(hereinafter referred to as "Retained Personal Information”) will be handled appropriately in accordance with the Act on
the Protection of Personal Information Held by Administrative Organs (Act No. 58 of 2003, hereinafter, “the Act”).
Retained Personal Information will only be used for the purpose of processing the visa application and to the extent
necessary for the purposes stated in Article 8 of the Act.
