The Philippine Embassy

Skeppsbron 20, 111 30 Stockholm

Kingdom of Sweden

MACHINE READABLE PASSPORT APPLICATION

PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK

LAST NAME / APELYIDO

4.5 cm X 3.5 cm
new colored
photo
with
ROYAL BLUE
background.

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

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

MIDDLE NAME / GITNANG PANGALAN

PLACE OF BIRTH / POOK NG KAPANGANAKAN

GENDER / KASARIAN:

Civil Status:

Single

MALE

Married

FEMALE

Widow/er

Separated/Divorced

Maiden or Single Name of Wife / Name of Husband (If applicable) ____________________________________________________________

First Name

Middle Name

Last Name

Mailing Address _________________________________________________________________________ Post Code _________________

Philippine Address _______________________________________________________________________ Tel. No. ___________________
E-mail Address _________________________________ Telephone no. _______________________ Mobile no. ______________________
Office Address __________________________________________________________________ Telephone no. ______________________
Present occupation ________________________________________
of applicant
First Name
Middle name
Last Name
Name of Father _____________________________________________________________________ Citizenship ___________________
of applicant
First Name
Middle name
Last Name
Name of Mother _____________________________________________________________________Citizenship ___________________

Philippine citizenship acquired by:

Birth
Election
Naturalization
Marriage
R.A. 9225
Others ________________

Purpose of Travel:
Tour
Business
Study
Work

Are you a holder of a foreign passport?

Yes
No
If Yes, from what country?

Have you ever been issued a Philippine Passport?

Yes
No
If Yes, latest Passport Number: _______________________
Date of Issue: ____________ Place of Issue_____________

______________________________________________________
This serves as Affidavit of Support and Consent to Travel
(for applicants below 18 years old ONLY)

Migration
Others

This serves as Affidavit of Loss

Name of minors traveling companion:_____________________________

Lost Passport Number: _____________________ Date lost:____________

Companions Relationship: ______________________________________

Issued on: ____________________ Issued by:_______________________

Address / Contact number: ______________________________________

Lost due to: __________________________________________________

______________________________________
______________________________________
Signature of Parent or Legal Guardian
Signature of Applicant
I SOLEMNLY 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) The attached photograph is
mine. 6) I am aware that under the law, I am allowed to hold only one Philippine passport at any given time. 7) I am aware that making false
statements in passport application, furnishing falsified or forged documents in support thereof are punishable by law.
Take care not to perforate
the photograph

Left
Thumbma

Right
Thumbma
SIGNATURE OF APPLICANT
Remarks:

4.5 cm X 3.5 cm
new colored photo
with
ROYAL BLUE
background

FOR STRICT COMPLIANCE: Please print name and affix initials

Processor _____________________________________________ Signing Officer_________________________________________________
RECEIVED CANCELLED PASSPORT:

RECEIVED NEW PASSPORT: