SUBIC-CLARK FREEPORT ZONE

PHILIPPINES
Subic Bay Metropolitan Authority
(6347) 252-4257/Fax: (6347) 252-4203

VAO-QF-VISA-02
Revision No: 03
Effectivity Date: 02-15-2018

REQUEST/APPLICATION FOR SPECIAL SUBIC-CLARK WORKING VISA (SCWV)

CONTROL NO: _________________________

STICKER NO: __________________________

The undersigned hereby requests for issuance of a Special Subic-Clark Working Visa (SS-CWV) with special multiple
entry privileges and with exemptions from exit clearances certificates, re-entry permits and special return certificates
pursuant to Memorandum of Agreement and Joint Memorandum No. 01-2009.

LI NAIYU
FIRST NAME MIDDLE NAME LAST NAME SIGNATURE

Age: _24 _ Sex: MALE __ Height: 170 CM Weight: 65 KG__________

Built: SMALL__________________ Race: CHINESE_______________ Blood Type: _O_________________
Eye Color: BLACK______________ Hair Color:_BLACK_________________ Complexion: _FAIR__________________

Philippine Address/Residence:
27A_KUMPANGN_ST._BINICTICAN,_SUBIC_BAY_FREEPORT_ZONE____________________________________________
_______________________________________________________________ Telephone : _(047) 250-2506 _______
Nationality CHINESE___________ Civil Status (Single, Married, Divorced, etc.) SINGLE______ _________
Passport No. EC6672154 _________________ Issued at GUANGDONG CHINA ____________________
Issued on _AUG 28, 2015__________________ Valid until _ SEP 26, 2020______________________________
Place of Birth _GUANGDONG______ Date of Birth __2 AUG 1994____ Personal ID No.___________________ ______

Employing Locator/Company in Freeport Zone_JUZ ELECTRONIC PROCESSING PLANT INC. _________________________

Locators Address_UNIT 1-2, BLDG. 1, LOT 1L-2, SUBIC BAY GATEWAY PARK, PHASE 2, SUBIC BAY FREEPORT
ZONE.__________________________________________ __________________________________________
_______________________________________________Position: ______ASST. DEPARTMENT MANAGER_________
Occupation Code __________________________________ Tel No. ______________________________________
Place of Assignment: __SUBIC BAY PHILIPPINES__________________ _________________________________________
E-mail Address: __juzelectronic.ph@gmail.com_____ _________________ Tel. No: _(047) 250-2506 ________

DEPENDENTS ACCOMPANYING THE PRINCIPAL IN THE PHILIPPINES

Name Age Sex Nationality
Spouse ______________________________________________ _______ ______ ____________________
Children ______________________________________________ _______ ______ ____________________
______________________________________________ _______ ______ ____________________
______________________________________________ _______ ______ ____________________
______________________________________________ _______ ______ ____________________
______________________________________________ _______ ______ ____________________
 AFFIDAVIT OF SUPPORT / GUARANTEE

I, ____________YU-SHEN KUO________________________________ of legal age, ____TAIWANESE___ ____________,

(Authorized Signatory of the Company) (Citizenship)
after having been duly sworn to in accordance with the law, do hereby depose and say:

1. That I am the ___VICE PRESIDENT/PLANT MANAGER__ __ , _____JUZ ELECTRONIC PROCESSING PLANT INC.
(designation) ( name of the Company)
a corporation and existing under the laws of the Philippines, with business address at UNIT 1-2, BLDG. 1, LOT 1L-2,
SUBIC BAY GATEWAY PARK, PHASE 2, SUBIC BAY FREEPORT ZONE_________________________________________.

2. That Mr./Ms. _______NAIYU LI _____________________is applying with the Subic Bay

(name of the applicant)
Metropolitan Authority a Special Subic–Clark Working Visa;

3. That in compliance with the requirements of applicable laws, rules and regulations, the corporation hereby
undertakes to support the stay of Mr./Ms.______________ NAIYU LI __________________________
(name of the applicant)
and assures the SBMA that he/she will not be of public charge while the corporation still exists inside the Freeport
Zone;

4. The corporation guarantees that Mr./Ms._____ NAIYU LI ____________________________ is in good

(Name of the applicant)
medical and psychological condition to perform his / her duties and services to the Company prior to the issuance
of the appropriate Working Visa by the Bureau of Immigration and endorsed by Subic Bay Metropolitan Authority
his stay in the Freeport Zone;

5. Finally, the Company shall promptly inform the SBMA should there be changes in his / her whereabouts.

That this affidavit is being executed to attest to the truth of the foregoing facts and for all legal intents and
purposes this may serve.

IN WITNESS WHEREOF, we have affixed hereto our signature this _______ day of _________________________,
20_____ at Subic Bay Freeport Zone.

Certified by: Conforme:

_____ YU-SHEN KUO__________________________ __ NAIYU LI __________________________

Printed Name & Signature of Authorized Signatory Printed Name and Signature of the Applicant
of the Company
_____ VICE PRESIDENT/PLANT MANAGER______________
Designation of Company’s Representative

Subscribed and sworn to me this _________ day of _____________________________________, 20 __________

Affiant exhibited his / her Passport No. ___________________________ issued at _________________________ on
_______________________________________.

Notary Public