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Republic of the Philippines

DEPARTMENT OF FOREIGN AFFAIRS
Embassy of the Republic of the Philippines, Riyadh

PASSPORT APPLICATION FORM (FA FORM NO. 79)

This application form is not for sale.
Please do not leave any spaces blank. Indicate N/A if not applicable.
Providing false statements in this passport application is punishable by law (R.A No. 8239).

LAST NAME / APELYIDO FIRST NAME / PANGALAN

PLACE OF BIRTH / POOK NG KAPANGANAKAN MIDDLE NAME / GITNANG PANGALAN

__________________ / _________ / ___________

Month Day Year [ ] Male [ ] Female
DATE OF BIRTH / PETSA NG KAPANGANAKAN GENDER / KASARIAN
( e.g., April / 25 / 2014 )

Civil Status: [ ] Single [ ] Married [ ] Widow/er [ ] Legally Separated [ ] Annulled [ ] Divorced

Complete Address in the Philippines _________________________________________________________

_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
Present Occupation________________________________________________________________________
Work Address in the Philippines or Abroad____________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
SSS No. ___________________ OWWA Membership ID No. (if any)_________________________________
Tax Identification No. (TIN) _________ Overseas Employment Certificate (OEC) No. (if any) _______________
Driver’s License No. _______________________ Pag-IBIG ID No. ___________________________________
PHILHEALTH ID No. ______________________ Community Tax Certificate (CEDULA) No. _______________

Name of Wife / Husband _________________________________________ Citizenship _________________

Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________

Name of Father _________________________________________________ Citizenship ________________

Maiden / Single Name of Mother ____________________________________ Citizenship________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________

In case of emergency, name of Next-of-Kin (NOK) to be contacted: __________________________________

Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________

Citizenship Acquired By:

[ ] Birth [ ] Election [ ] Marriage [ ] Naturalization [ ] R.A. 9225 [ ] Others ___________________
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Are you a holder of a foreign passport? Have you ever been issued a Philippine Passport?
[ ] YES [ ] NO [ ] YES [ ] NO

If YES, from what country? If YES, please provide:

Latest Passport No. ______________________________
________________________________________ Date of Issue ___________________________________
Place of Issue __________________________________

For Applicants below 18 years old ONLY

Name of Minor’s Traveling Companion __________________________________________________________

Companion’s Relationship to the Minor _________________________________________________________

Complete Address ________________________________________________ Tel. No. __________________

I SOLEMNLY SWEAR that 1) I am a Filipino citizen; 2) the information in this application are true and correct;
3) the supporting documents are authentic; 4) I am aware that under the law I am allowed to hold only one
Philippine Passport at any given time; and, 5) I am aware that making false statements in this 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.
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REMARKS:

Processor: Encoder: Signing: Transmission Officer:

RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:

FOR ADMINISTRATIVE USE ONLY

For more details, please visit www.dfa.gov.ph