ONLINE REGISTRATION

(For U.S. Immigrant Visa Applicants Only)

Upon arrival at SLEC, applicants WILL BE ACCOMMODATED ON A FIRST-COME, FIRST-SERVED BASIS ON THEIR SCHEDULED VISA MEDICAL DATE. This online registration form aims to reduce registration time by having most of the applicant's information ready upon arrival at the registration area. Pre-registered applicants should only need to have their biometrics captured upon arrival at the reception area.

INSTRUCTIONS:

COMPLETE ALL FIELDS. KNOW ALL DETAILS OF YOUR APPLICATION BEFORE ACCOMPLISHING THE ONLINE REGISTRATION FORM.
FOR FAMILIES, AN ONLINE REGISTRATION MUST BE SUBMITTED FOR EACH FAMILY MEMBER. FAMILIES WITH INCOMPLETE ONLINE APPLICATIONS WILL NOT BE ACCOMMODATED AT THE RECEPTION AREA.

PLEASE TYPE YOUR COMPLETE ADDRESS. DO NOT ABBREVIATE ANY DETAILS PERTAINING TO THE STREET, CITY, OR STATE.

Once all fields have been filled out, Click on the 'Preview' button. The next step will display a preview of all data entered.
Review data for errors. Use the form to correct them as needed, click 'Preview', to preview data to be submitted.
If all data are correct, click on the 'Register' button to submit your registration.

ALL APPLICANTS WILL BE SERVED ON A FIRST-COME, FIRST-SERVED BASIS ON THEIR PREFERRED VISA MEDICAL DATE.

PLEASE COMPLETE REGISTRATION BEFORE PRINTING THIS PAGE.
Your registration has NOT been submitted. This printout will not be honored when presented at SLEC. Refer to the instructions found at the beginning of the registration form to complete your registration.

NOTE: ONLINE REGISTRATION SUBMISSIONS ARE ONLY VALID FOR ONE MONTH. PLEASE REGISTER NO EARLIER THAN ONE MONTH BEFORE YOUR INTENDED DATE OF MEDICAL EXAM.

CASE INFORMATION

NVC Case Number* 3-character Consulate Code+10-digit case number (ex. MNL##########) Confirm NVC Case Number* Please re-enter your NVC Case Number

Visa Preference Category*

Interview Date if none, leave blank'

Interview Source Where was your Visa Interview Appointment set?

Preferred Date of Medical Examination

APPLICANT DETAILS

Basic Information (as indicated in passport)

Name (Last Name, First Name, Middle Name)*

Last Name

First Name

Middle Name

Date of Birth* Birth Date (mm/dd/yyyy)

Gender*

Civil Status*

Birthplace * Birth City

Birth Country

Contact Information

FOR APPLICANTS CURRENTLY LIVING IN THE PHILIPPINES:

PHILIPPINE ADDRESS

Building name and Street Address

City/Town

Province

Zip Code

FOR APPLICANTS CURRENTLY LIVING OUTSIDE THE PHILIPPINES:

OVERSEAS ADDRESS

Country*

Street Address

City/Town

Province/State

Zip Code

Contact Number(s), separate with a slash* (Area Code)<space>Tel.Number.

Email Address* Must be active, will be used for confirmation.

Note: We are currently having issues sending confirmation emails to Hotmail/Live/MSN/Outlook.com email addresses. Please try a different email address.

Present Country of Residence*

Prior Country of Residence* Date of residence not more than 6 months prior to current date

Passport Information

NOTE: Passport must be more than 6 months valid.

Passport Number*

Issued by (Country)*

Issue Date*

Expiration Date*

Additional Questions

Have you been issued a U.S. Tourist Visa?* No Yes
Issuance Date
Expiration Date

Previous Medical Examination at SLEC

Month and Year only.

Date of Previous Chest X-ray

Month and Year only.

PETITIONER'S INFORMATION

Name of Petitioner*
Please enter the petitioner's full name.

Is the Petitioner still alive?* Yes No

U.S. Address*
Street Address

Relationship* Petitioner is Applicant's __.

City

State

Postal Code

Contact Number*

Email Address*

Intended Port of Entry* Select Intended Port of Entry