REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FOREIGN AFFAIRS
MANILA
E-PASSPORT APPLICATION

For inquiries.
please call (02) 556 0000
or visit http://www.dfa.gov.ph

NOT FOR SALE

PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK.

_______________________________________________

_________________________________________________

LAST NAME / APELYIDO

MIDDLE NAME / GITNANG PANGALAN

_______________________________________________

________________________________________________

FIRST NAME / PANGALAN (Jr. / II / III)

PLACE OF BIRTH / POOK NG KAPANGANAKAN

_______________________________________________

DATE OF BIRTH (Ex. 01-January-2000)

GENDER / KASARIAN:

MALE

FEMALE

PETSA NG KAPANGANAKAN

Single

Civil Status:

Married

Widow/er

Legally Separated

Annulled

Name of Wife / Husband: ____________________________________________ Citizenship: ______________
First Name

Middle Name

Last Name

Complete Address: _________________________________________________ Tel. No.:

______________

Present Occupation: _________________________________________________ Mobile No.:

______________

Work Address:

____________________________________________________________________________

E-mail Address:

__________________________________________________ Tel. No.:

Name of Father:

__________________________________________________ Citizenship: ______________
First Name

Maiden/Single
Name of Mother:

Middle Name

Last Name

__________________________________________________ Citizenship: ______________
First Name

Middle Name

Citizenship Acquired By:
Election

R.A. 9225

Others

Marriage

Naturalization

_______________________

Are you a holder of a foreign passport?
If Yes, from what country?

Last Name

Purpose of Travel:

Birth

Yes

No

_______________________

This serves as Affidavit of Support and Consent to Travel
(for Applicants below 18 years old ONLY)
Name of minor’s traveling
_________________________
companion:
Companion’s Relationship:
Address / Contact
Number:

______________

_________________________

_________________________
___________________________
Signature of Parent or Legal Guardian

Tour

Seaman

Business

Study

Work

Others

Migration

____________

Have you ever been issued a Philippine Passport?

Yes

No

If Yes, Latest Passport Number? ______________________
Date of Issue: __________ Place of Issue: _____________
This serves as an Affidavit of Loss
Lost Passport Number: ___________________________
Issued on: ______________ Issued by: ___________
Date lost:
Lost due to:

__________________________________
__________________________________
___________________________
Signature of Applicant

I SOLEMNY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The
supporting documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am
allowed to hold only one Philippine passport at any given time. 6) 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
REMARKS:
FOR STRICT COMPLIANCE: Please print name and affix initials.
Processor:
RECEIVED CANCELLED PASSPORT:

Encoder:

Signing Officer:
RECEIVED NEW PASSPORT: