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E-Passport Application Form Rev. July 2012

E-Passport Application Form Rev. July 2012

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Published by Oliver380
from The Philippine Department of Foreign Affairs
Passport Application/Renewal form

for more info. Please visit www.dfa.gov.ph
from The Philippine Department of Foreign Affairs
Passport Application/Renewal form

for more info. Please visit www.dfa.gov.ph

More info:

Published by: Oliver380 on May 05, 2013
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05/06/2013

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Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
PASSPORT APPLICATION FORM
THIS APPLICATION FORM IS NOT FOR SALE. PLEASE DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE. PROVIDING FALSE STATEMENTS IN PASSPORT APPLICATIONS IS PUNISHABLE BY LAW (R.A. 8239).
Civil Status
:
Single
Married
Widow/er 
Legally Separated
AnnulledComplete Address: ________________________________________________________ Tel. No.:____________________Present Occupation: _______________________________________________________ Mobile No.:_________________Work Address: ____________________________________________________________ Tel. No.:____________________E-mail Address: _______________________________________________________________________________________Name of Wife / Husband: ____________________________________________________ Citizenship: _________________Name of Father: ___________________________________________________________ Citizenship: _________________Maiden / Single name of Mother: ______________________________________________ Citizenship: _________________
Citizenship Acquired By:
Birth
Election
Marriage
Naturalization
R.A. 9225
Others _______________________ Are you a holder of a foreign passport?
Yes
NoIf Yes, from what country?___________________Have you ever been issued a Philippine Passport?
Yes
NoIf Yes, latest Passport Number? _______________________Date of issue: _________________ Place of issue: __________
(For applicants below 18 years old ONLY)
Name of minor’s trave
lling companion: ________________________________________________________________
Companion’s
relationship: _________________________ Contact Number: __________________________________
I SOLEMNLY SWEAR
that 1) I am a Filipino citizen. 2) The information I provided in this application are true andcorrect. 3) The supporting documents attached are authentic. 4) I am aware that under the law, I am allowed to hold only onePhilippine passport at any given time. 5) I am aware that making false statements in passport application, furnishing falsified or forged documents in support thereof are punishable by law.
 ______________________________________________
Signature of Applicant or Legal Guardian (for minor applicants)FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRS ONLY. PLEASE DO NOT WRITE BELOW THIS LINE.
REMARKS:
Processor: Encoder: Signing Officer: Transmission Officer:
RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:FOR ADMINISTRATIVE USE ONLY:
For more details please visit  
or 
 _______________ 
 ________________________ ___________________________________________ 
LAST NAME
/ APELYIDO
FIRST NAME
/ PANGALAN (Jr./II/III) ____________________________________________ ________________________________________________
MIDDLE NAME
/ GITNANG PANGALAN
PLACE OF BIRTH
/ POOK NG KAPANGANAKAN ____________________ / __________ / ___________
GENDER
/ KASARIAN
MALE
FEMALEMonth Day Year 
DATE OF BIRTH
/ PETSA NG KAPANGANAKAN(Ex.: March 8, 2010)
JVBL-APCE-LVJZ-PPT-DO Rev. July 2012

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