US VISA APPLICATION
FOR VISA SECTION USE ONLY: ENCODED BY: VESSEL ASSIGNMENT:________________________
DS 160 NO.:
VESSEL: CHECKED AND SUBMITTED BY: VESSEL IMO NO.:_____________________________
DATE OF ARRIVAL:
INTENDED DATE OF ARRIVAL TO U.S.: _______dd _______ mm _______yyyy
DATE HIRED: OCTOBER 28, 2019 DATE REPORTED: MARCH 22, 2022
FLEET MANAGER: NAME & SIGN: CRISTINA B. YUSON POSITION: MESSMAN
FLEET: CMA-CGM SIGN OFF: MARCH 18, 2022
PASSPORT NO.: P9662751B LOST A PASSPORT? YES NO
ISSUE DATE: APRIL 19, 2022 REASON:
EXPIRY DATE: APRIL 18, 2032
SIRB NO.: C1462262 EXPIRY DATE: SEPTEMBER 18, 2028
FULL NAME: OLITA , ALEXANDER MARKINES
LAST NAME FIRST NAME MIDDLE NAME
BIRTHDATE: 10 07 1992 PLACE OF BIRTH: MACROHON, SOUTHERN LEYTE
dd mm yyyy
GENDER: M AGE: 29 NATIONALITY: FILIPINO
CIVIL STATUS: MARRIED CELLPHONE NO.: 09276795855
HOME ADDRESS: S. BANTUG ST., TUNGA-TUNGA, MAASIN CITY, SOUTHERN LEYTE ZIP CODE: 6600
SPOUSE MULAAN , LYN ORAG
MAIDEN NAME: LAST NAME FIRST NAME MIDDLE NAME
BIRTHDATE: 04 08 1989 PLACE OF BIRTH: MAASIN, SOUTHERN LEYTE
dd mm yyyy NATIONALITY: FILIPINO
HAVE YOU EVER BEEN IN THE US: YES NO
IF YES, WHEN?
23 ''$$$$
!" ##$$$$ 03 ))$$$$
2016 4 days
!"# $"%&' ((((((((
12 yy____
28 mm____
2. dd____ 2017 3 days
!"# $"%&' ((((((((
14 mm____
3. dd____ 2019
04 yy____ 3 days
!"# $"%&' ((((((((
4. dd____ mm____ yy____ !"# $"%&' ((((((((
5. dd____ mm____ yy____ !"# $"%&' ((((((((
DO YOU HAVE PREVIOUS VISA? YES NO IF YES: C1/D
TYPE: ___________
DATE OF ISSUE: APRIL 7, 2015
HAVE YOU EVER BEEN DENIED?: YES NO
IF YES: REASON? WHEN?
dd mm yyyy
FATHER'S NAME: JARABE , EXEQUIEL DELPIN
LAST NAME FIRST NAME MIDDLE NAME
BIRTHDATE: 10 04 1927 IS YOUR FATHER IN THE U.S.? YES NO
dd mm yyyy IF YES, STATUS? ___CITIZEN __ LEGAL RESIDENT ___NON-IMMIGRANT ___WORKING
MOTHER'S OLITA , ESMERALDA MARKINES
MAIDEN NAME: LAST NAME FIRST NAME MIDDLE NAME
BIRTHDATE: 29 09 1957 IS YOUR MOTHER IN THE U.S.? YES NO
dd mm yyyy IF YES, STATUS? ___CITIZEN __ LEGAL RESIDENT ___NON-IMMIGRANT ___WORKING
DO YOU HAVE ANY RELATIVE IN THE US? YES NO
IF YES, NAME:
RELATIONSHIP:
STATUS OF RESIDENCY:
DIFFERENT COUNTRIES YOU HAVE VISITED IN THE LAST 5 YEARS: (not included U.S.A.)
FRANCE
1.) ___________________________ SPAIN
6.) ___________________________
BELGIUM
2.) ___________________________ SINGAPORE
7.) ___________________________
ROTTERDAM
3.) ___________________________ SOUTH KOREA
8.) ___________________________
4.) ___________________________
GERMANY 9.) ___________________________
HONG KONG
LONDON
5.) ___________________________ MALAYSIA
10.) ___________________________
LAST EMPLOYER BEFORE DIVERSIFIED:
SOUTHFIELD :
COMPANY: SOUTHFIELD AGENCIES, INC. RANK: MESSMAN
STARTED: 18 03 2014 UNTIL: 06 12 2018
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ADDRESS: 2115 MADRE IGNACIA ST., MALATE, MANILA SUPERVISOR: CAPT. SONNY D. VALENCIA
CONTACT NO.: _________________________
(632) 304-1888
EDUCATIONAL ATTAINMENT
557 MAGSAYSAY ST., SIBULAN,
HIGH SCHOOL: SIBULAN NATIONAL HIGH SCHOOL ADDRESS: NEGROS ORIENTAL
INCLUDE STREET NAME
STARTED: 03 06 2004 UNTIL: 31 03 2008 ZIP CODE:__________________
6201
dd mm yyyy dd mm yyyy
CAPITOL AREA, KAGAWASAN AVE., DUMAGUTE,
COLLEGE: NEGROS ORIENTAL STATE UNIVERSITY ADDRESS: NEGROS, ORIENTAL
INCLUDE STREET NAME
STARTED: 03 06 2008 UNTIL: 31 03 2009 ZIP CODE:__________________
6200
dd mm yyyy dd mm yyyy
COURSE: BACHELOR OF SCIENCE IN MARINE TRANSPORTATION
TECHNICAL SCHOOL: ASIAN INSTITUTE OF CULINARY ARTS ADDRESS:
INCLUDE STREET NAME #68 SEN. GIL PUYAL AVE.,MAKATI CITY
STARTED: 11 06 2013 UNTIL: 06 12 2013 ZIP CODE:__________________
1224
dd mm yyyy dd mm yyyy
COURSE: COMPREHENSIVE CULINARY ARTS PROGRAM WITH MENU PLANNING
MEDIA FLATFORM:
FACEBOOK | INSTAGRAM | TIK TOK | TWITTER | YOUTUBE
MEDIA FLATFORM USER I.D.: ALEXANDER MARKINES OLITA
MONTHLY INCOME (IN PESO): P60,000.00
BRIEFLY DESCRIBE YOUR DUTIES ONBOARD:
___________________________________________________________________________________
ASSIST CHIEF COOK IN PREPARING MEALS; MAINTAIN CLEANLINESS OF THE GALLEY, COLD ROOMS,
___________________________________________________________________________________
DRY STORE AND MESSROOM.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
REMINDER:
In the authorization letter kindly fill up the blank and put your FULL NAME
and CONTACT NUMBER before you sign.
January 28, 2022
LBC EXPRESS
Ground Floor Ayala Life FGU Center,
#6811 Ayala Avenue, Makati City
1200 Metro Manila
To Whom It May concern:
Good day!
I, __________________________________
ALEXANDER M. OLITA residing at ______________________________
S. BANTUG ST., TUNGA-TUNGA,
___________________________________
MAASIN CITY, SOUTHERN LEYTE hereby authorizes __________________residing
at 19th Floor Salcedo Towers, 169 H.V. Dela Costa St., Salcedo Village, Makati City to pick
up the parcel on my behalf, including the signing of the proof of delivery.
OTHER INFORMATION:
Applicant’s fee receipt number: (kindly see attached)
Sincerely yours,
A.Olita
ALEXANDER M. OLITA
