Important Reminders

☐
Your appointment is on Wednesday, Jan 17, 2018 at 15:00 - 16:00.
Please be at DFA NCR North (Robinsons Novaliches) at least thirty (30) minutes
before your scheduled appointment.

☐ Please make sure you have prepared all the requirements.

☐
Be ready with both the original and photocopies of your documents when you
appear for personal appearance. Application processing may be delayed if
applicants are not ready with copies of their documents once inside the data
capturing site.

☐ For your NSO certificate requirements, you may call (02) 737-1111. Nationwide
delivery within 3-4 days.

☐
Kindly print your application form (with barcode) in A4-size paper.
You must have a printed application form to show and submit at your chosen
application site.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
DFA NCR North (Robinsons DEPARTMENT OF FOREIGN AFFAIRS
Novaliches)
Wednesday, Jan 17, 2018 PASSPORT APPLICATION FORM
15:00 - 16:00
THISAPPLICATIONFORMIS NOT FORSALE. PLEASEDONOT LEAVEANY SPACES BLANK, INDICATE N/AIF NOT APPLICABLE. PROVIDINGFALSE
STATEMENTS INPASSPORT APPLICATIONSIS PUNISHABLE BY LAW(R.A. 8239).

_______________________________________
DAVE ___________________________________________
RAEL JR
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
DASOLVO ________________________________________________
PHILIPPINES /CALOOCAN CITY
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
OCTOBER / __________
26 / ___________
1986 GENDER/ KASARIAN □ MALE □ FEMALE
Month Day Year
DATE OF BIRTH/ PETSA NG KAPANGANAKAN
(Ex.: March8, 2010)

Civil Status: □ Single □ Married □ Widow/er □ Legally Separated □ Annulled

Complete Address: 8424
________________________________________________________
LALOMA GROUP CAMARIN, CALOOCAN CITY, NCR Tel. No.:____________________
Present Occupation:ONLINE
_______________________________________________________
BUSINESS Mobile No.:_________________
+9163033558
Work Address: ____________________________________________________________ Tel. No.:____________________
E-mail Address: ALEXZAIRA@YAHOO.COM
_______________________________________________________________________________________
Name of Wife / Husband: ____________________________________________________ Citizenship: _________________
Name of Father: RAEL
___________________________________________________________
SR BUIZON DAVE Citizenship:PHL
_________________
Maiden/ Single name of Mother:FELICISIMA
______________________________________________
LEGASPI DASOLVO Citizenship:PHL
_________________

Citizenship Acquired By:

□ Birth □ Election □ Marriage □ Naturalization □ R.A. 9225 □ Others _______________________
Are you a holder of a foreign passport? □ Yes □ No Have you ever been issued a Philippine Passport? □ Yes □ No
If Yes, from what country?___________________ If Yes, latest Passport Number? _______________________
EB6487691
Date of issue: _________________
10-04-2012 Place of issue: DFA
__________
MANILA
(For applicants below 18 years old ONLY)
Name of minor’s travelling 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 and
correct. 3) The supporting documents attached are authentic. 4) I am aware that under the law, I am allowed to hold only one
Philippine 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)

ORGAN DONATION (Optional)

In case of death, I hereby donate [ ] Any organ / tissue [x ] Specific organ N/A
____________________ to save other people.
Please immediately notify my family at mobile / tel. no. RACHELL
___________________________.
DAVE/ +09307837657

FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRSONLY. PLEASE DO NOT WRITE BELOWTHIS LINE.

REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer:

RECEIVEDCANCELLED PASSPORT: RECEIVEDNEWPASSPORT:
FOR ADMINISTRATIVE USE ONLY:
For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph