APPLICANT TYPE

NEW
1. ID PRESENTED
34-4777093-2
2. PURPOSE TYPE
LOCAL
3. PURPOSE APPLICATION
LOCAL EMPLOYMENT
BASIC INFORMATION
5. FAMILY NAME
AQUINO
6. HUSBAND FAMILY NAME (FOR MARRIED
WOMAN ONLY)
7. GIVEN NAME
REGIDOR III
8. MIDDLE NAME
AMAMEO
9. NICKNAME
REED
10. OTHER NAME/ALSO KNOW AS
REED
11. DATE OF BIRTH
07/29/1991
12. BIRTH PLACE
SALVADOR T. VILLA MEMORIAL
HOSPITAL KALOOKAN CITY
13. CITIZENSHIP
FILIPINO
14. GENDER
MALE
15. CIVIL
STATUS
SINGLE
16. SPOUSE

17. BIRTH PLACE

18. PRESENT ADDRESS
2460 OROQUITA STREET STA. CRUZ MANILA
19. CONTACT NUMBER
09125831909
20. EMAIL ADDRESS
REEDAQUINO@YAHOO.COM
21.
IDENTIFYING
MARKS
MOLE
RIGHT SIDE
ADDITIONAL INFORMATION
22. HEIGHT
55
23.
WEIGHT
24. COMPLEXION
BROWN
25. RELIGION
OTHER

REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF JUSTICE
NATIONAL BUREAU OF
INVESTIGATION

NBI CLEARANCE APPLICATION
FORM
A2503893870

55
26. EDUCATIONAL ATTAINMENT
COLLEGE GRADUATE
27. OCCUPATION
EMPLOYMENT
PARENTS INFORMATION
28. NAME OF FATHER
REGIDOR M. AQUINO SR.
29. FATHER BIRTH PLACE
PANGASINAN
30. NAME OF MOTHER
LIGAYA B. AMAMEO
31. MOTHER BIRTH PLACE
CALBAYOG CITY
FOR ALIEN APPLICANT'S ONLY
32. FOREIGN NAME
-
33. ADDRESS ABROAD
-
34. PASSPORT NUMBER

35. DATE ISSUED
-
36. PLACE
ISSUED
-
37. ACR NUMBER
-
38. DATE ISSUED
-
39. PLACE
ISSUED

I certify that I have read and understood all the questions set forth in this application and answer
I have furnished on this form are true and correct to the best acknowledge and belief. I
understand that any false or misleading statement is FALSIFICATION PUNISHABLE UNDER
ARTICLE 171 & 172 OR REVISED PENAL CODE

________________________________

________________________________
36. DATE

37. SIGNATURE
2014 All Rights Reserved