Important Reminders

☐
Your appointment is on Jun 30, 2020 at 09:00 AM - 10:00 AM.
Please be at Tuguegarao (Reg. Gov't Center, Tuguegarao City) at 15-30 minutes before your
scheduled appointment.

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Please make sure you have prepared all the requirements.
You may refer to https://consular.dfa.gov.ph/passport
Processing fee is non-refundable and non-transferable.

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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.

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For your NSO/PSA Certificate requirements you may contact https://www.ecensus.com.ph

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Kindly print your application form (with barcode) and e-receipt on A4-size paper. You must
have a printed application form and e-receipt to show and submit at your chosen application
site.

Steps at the Data Capturing Site

Have your appointment verified at the verification section.
Present your duly accomplished application form, an ID, and your e-receipt.
Step 1 Please double check that the verifier has signed or stamped your form before
proceeding to the next step.

Present your verified application form and requirements to the processor.

Please note that you MAY be required to present other requirements.
Step 2 Payment of Processing Fee does not guarantee approval of your application.
If approved, double check that the processor has signed your form.

Once approved, proceed to the data capturing / encoding section. Please remove all
hair accessories, colored contact lenses, piercings on the face and ears while waiting
Step 3 your turn.
When your photo has been captured and your information encoded, please double
check that all information entered is complete and correct.
At Consular Offices: You may opt in for courier services. Please approach any of the
couriers inside the capture site.
Step 4 Passporting on Wheels: Courier services are mandatory.

Reminders
Please wear clothing that will cover your shoulders. Avoid wearing strapless, spaghetti-strapped, or tank
tops; halters; backless; see-through or cut-out tops; and deep necklines. Please do not wear shorts,
shorts skirts. Please wear shoes. Remember, you are entering a government office. Please dress
appropriately.
You want to look good in your passport photo, but please do not put on heavy or theatrical make-up.
This may result with you having to remove your make-up during the photo.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
Tuguegarao (Reg. Gov't DEPARTMENT OF FOREIGN AFFAIRS
Center, Tuguegarao City)
Tuesday, Jun 30, 2020
09:00 - 10:00 PASSPORT APPLICATION FORM
THISAPPLICATIONFORMIS NOT FORSALE. PLEASEDONOT LEAVEANY SPACES BLANK, INDICATE N/AIF NOT APPLICABLE. PROVIDINGFALSE
STATEMENTS INPASSPORT APPLICATIONSIS PUNISHABLE BY LAW(R.A. 8239).

LAZO
_______________________________________ SOLEDAD
___________________________________________
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
MELLENDRES
____________________________________________ PHL /BALLESTEROS, CAGAYAN
________________________________________________
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

JANUARY
____________________ 18 / ___________
/ __________ 1968 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

D
Complete Address: 141
________________________________________________________
CORTEZ EXTENSION ,AMMUBUAN ,BALLESTEROS,CAGAYAN BALLEST… Tel. No.:____________________
Present Occupation:TEACHING
_______________________________________________________ Mobile No.:_________________
09268118491

I
Work Address: ____________________________________________________________
AMMUBUAN, BALLESTEROS, CAGAYAN Tel. No.:____________________
E-mail Address: SOLEDAD.LAZO@DEPED.GOV.PH
_______________________________________________________________________________________
Name of Wife / Husband: PAULINO
____________________________________________________
MANGAWILI LAZO Citizenship:PHL
_________________
Name of Father: JESUS
___________________________________________________________
UBARRE MELLENDRES Citizenship:PHL
_________________
Maiden/ Single name of Mother:BRIGIDA
______________________________________________
RAMOS ROSARIO Citizenship:PHL
_________________

A
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? _______________________
EC5555583

P
Date of issue: _________________
30-09-2015 Place of issue: __________
(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 [ ] Specific organ N/A
____________________ to save other people.
Please immediately notify my family at mobile / tel. no. PAULINO
___________________________.
M. LAZO / 09269933637

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:

E-Receipt No: 2000571516 For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph

 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 2000571516

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 1390
REFERENCE NO: DFKMPJCD21
DATE: 24-June-2020
TIME: 09:14:10 AM

APPOINTMENT NUMBER: 00292020063000127

NAME: SOLEDAD LAZO

TRANSACTION:
O Y
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUEGARAO CITY)

P
REGULAR

FA C
PROCESSING TYPE: PASSPORT PROCESSING
MODE OF PAYMENT: CASH

D
SERVICE NUMBER:

AMOUNT
2000571516
(E-PASSPORT FEE) P950.00
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 2000571516

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 1390
REFERENCE NO: DFKMPJCD21
DATE: 24-June-2020
TIME: 09:14:10 AM

APPOINTMENT NUMBER: 00292020063000127

NAME: SOLEDAD LAZO

NT
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUEGARAO CITY)

A
TRANSACTION:

PLIC
REGULAR

Y
PROCESSING TYPE: PASSPORT PROCESSING

P
A CO
SERVICE NUMBER:
P
MODE OF PAYMENT: CASH
2000571516
(E-PASSPORT FEE) P950.00
AMOUNT