FA FORM NO. 2-A

  1.  NAME _____________________________________________________________
                  (Surname)         (First Name)            (Middle Name)

  2.  SEX ___Male ___Female

  3.  AGE___   PLACE OF BIRTH_________________  DATE OF BIRTH___________

  4.  CIVIL STATUS ___Single ___Married ___Widowed/Widower  
                   ___Divorced ___Separated

  5.  CITIZENSHIP__________________________

  6.  PASSPORT NO._________________________     DATE OF ISSUE___/___/___

  7.  PRESENT ADDRESS___________________________________________________
      Telephone No._______________________(H)  _______________________(W)

  8.  OCCUPATION ________________________________________________________

  9.  PURPOSE OF ENTRY __________________________________________________

10.  LENGTH OF INTENDED STAY IN THE PHILIPPINES _________________________

11.  EXPECTED DATE OF DEPARTURE FROM MALAYSIA  __________________________

12.  FINANCIAL MEANS OF SUPPORT WHILE IN THE PHILIPPINES ________________
     ____________________________________________________________________

13.  ADDRESS IN THE PHILIPPINES _________________________________________

14.  REFERENCE and/or IMMEDIATE RELATIVES IN THE PHILIPPINES ____________
     ____________________________________________________________________

15.  PORT OF NEXT DESTINATION IN THE PHILIPPINES ________________________
     ____________________________________________________________________ 

16.  NAME(s) OF CHILDREN (INCLUDED IN THE PASSPORT) ACCOMPANYING THE
     APPLICANT __________________________________________________________
     ____________________________________________________________________

17.  WERE YOU EVER REFUSED ANY KIND OF VISA OR DENIED ADMISSION TO OR
     DEPORTED/REMOVED AT GOVERNMENT EXPENSE FROM THE PHILIPPINES?
     YES _______
     NO  _______

          I SOLEMNLY SWEAR THAT THE FOREGOING ARE TRUE TO THE BEST OF MY
     KNOWLEDGE AND ABILITY.


                                                   ______________________
                                                   SIGNATURE OF APPLICANT

FOR OFFICIAL USE ONLY: Passport Visa No. _____________________ Granted on ____________________ as non-immigrant under Section __________ of the Philippine Immigration Act of 1940, as amended, valid until ____________________________.