Important Reminders

☐ Your appointment is on Friday, Aug 16, 2019 at 13:00 - 14:00.

Please be at Santiago, Isabela (Robinsons Place Santiago) 15-30 minutes before
your scheduled appointment.

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

☐
Be ready with both the original and photocopies of your documents during your
appointment. Application processing may be delayed if applicants are not
ready with copies of their documents once inside the data capturing site.

☐ For your NSO/PSA Certificate requirements, you may contact

https://www.ecensus.com.ph/

☐
Kindly print your duly accomplished 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.
Step Present your duly accomplished application form, an ID, and your e-receipt.
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
Step processor. Please note that you MAY be required to present other
2 requirements.
There is no 100% guarantee your application wil be approved on the same
day. If approved, double check that the processor has signed your
form.
Once approved, proceed to the data capturing / encoding section. Please
Step remove a l hair accessories, colored contact lenses, piercings on the face and
3 ears while waiting your turn.
When your photo has been captured and your information encoded, please
double check that a l information entered is complete and correct.

Step 4 You may opt in for courier services. Please approach any of the couriers
(optional) inside the capture site.

Reminders
Please wear clothing that wil 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 o
fice. 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
Santiago, DEPARTMENTOFFOREIGNAFFAIRS
Isabela
(Robinsons Place PASSPORT APPLICATION FORM
Santiago)
Friday,
2019 Aug 16,
T1H3IS:A0P0PL-ICA1TI4O:N0F0ORMISNOTFORSALE. PLEASEDONOTLEAVEANYSPACESBLANK,
INDICATEN/AIFNOTAPPLICABLE. PROVIDINGFALSE STATEMENTSINPASSPORTAPPLICATIONSISPUNISHABLEBYLAW(R.A. 8239).

OC_A_MP_O MARK JAYSON

LAST NAME/ APELYIDO FIRST NAME/ PANGALAN(Jr./II/III)
BUN_AG PHILIPPINES /SANTIAGO CITY
MIDDLE NAME/ GITNANGPANGALAN PLACE OF BIRTH/ POOKNGKAPANGANAKAN

JULY/ 28/ 1993 GENDER/ KASARIAN □ MALE□ FEMALE

MonthDayYear DATE OF BIRTH/ PETSANGKAPANGANAKAN (Ex.: March8, 2010)

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

Annulled Complete Address: N_O_._6_8 P_-_1 B_A_R_A_N_G_A_Y SI_N_S_A_Y_O_N_, S_A_N_T_I_A_G_O
C_I_T_Y_,_I_S_A_B_E_L_A_, S_A_N_T_I_A… Tel. No.:
Present Occupation:T_E_A_C_H_I_N_G Mobile No.:+_6_3_9_5_5_8_3_2_9_3_9_1
Work Address: Tel. No.:
E-mail Address: O_M_A_R_K_J_A_Y_S_O_N_0_5_@_G_M_A_IL_._C_O_M
Name of Wife / Husband: Citizenship:
Name of Father:
R_O_B_E_R_T S_R_. L_E_S_T_E O_C_A_M_PO Citizenship:P_H_L
Maiden/ Singlename of Mother: _ _ _ _ _ _ _ _ _ _ _
L O R E N A G O N Z A G A BU___
N A G Citizenship:P_H_L
Citizenship Acquired By:
□
Birth □ Election □ Marriage □ Naturalization □ R.A. 9225 □ Others
□ □
Are youa holder of aforeign passport? □ Yes Have you ever been issued a Philippine Passport? □ Yes
No No
If Yes, fromwhat country? If Yes, latest Passport Number?
Date of issue: Place of issue:
(For applicants below18 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 amaware that under the
law, I amallowed to hold only one Philippine passport at any given time. 5) I amaware 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. CHRISTIAN B. OCAMPO/ +639267 .

FORUSEOFTHEDEPARTMENTOFFOREIGNAFFAIRSONLY. PLEASEDONOTWRITEBELOWTHISLINE.

REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer:

RECEIVEDCANCELLEDPASSPORT: RECEIVEDNEWPASSPORT:
FORADMINISTRATIVEUSEONLY:
E-Receipt No: For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph
1901645684
 Republic of the Philippines
DEPARTMENTOFFOREIGNAFFAIRS

ELECTRONIC RECEIPT NO. 1901645684

PAYMENT DETAILS:
MERCHANT: ECPA
BRANCH Y 71112434
REFERENCE
CODE: NO:
DATE:
DF55PXLTX223-July-2019
TIME: 06:28:23 PM

APPOINTMENT NUMBER: 04252019081600026

NAME: MARK JAYSON BUNAG OCAMPO
SITE NAME: SANTIAGO, ISABELA (ROBINSONS PLACE SANTIAGO)
TRANSACTION: PASSPORT PROCESSING
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1901645684
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00
APPOINTMENT NUMBER: 04252019081600026
NAME: MARK JAYSON BUNAG OCAMPO
SITE NAME: SANTIAGO, ISABELA (ROBINSONS PLACE SANTIAGO)
TRANSACTION: PASSPORT PROCESSING
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1901645684
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00
Important Reminders

☐ Your appointment is on Friday, Aug 16, 2019 at 13:00 - 14:00.

Please be at Santiago, Isabela (Robinsons Place Santiago) 15-30 minutes before
your scheduled appointment.

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

☐
Be ready with both the original and photocopies of your documents during your
appointment. Application processing may be delayed if applicants are not
ready with copies of their documents once inside the data capturing site.

☐ For your NSO/PSA Certificate requirements, you may contact

https://www.ecensus.com.ph/

☐
Kindly print your duly accomplished 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.
Step Present your duly accomplished application form, an ID, and your e-receipt.
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
Step processor. Please note that you MAY be required to present other
2 requirements.
There is no 100% guarantee your application wil be approved on the same
day. If approved, double check that the processor has signed your
form.
Once approved, proceed to the data capturing / encoding section. Please
Step remove a l hair accessories, colored contact lenses, piercings on the face and
3 ears while waiting your turn.
When your photo has been captured and your information encoded, please
double check that a l information entered is complete and correct.

Step 4 You may opt in for courier services. Please approach any of the couriers
(optional) inside the capture site.

Reminders
Please wear clothing that wil 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 o
fice. 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
Santiago, DEPARTMENTOFFOREIGNAFFAIRS
Isabela
(Robinsons Place PASSPORT APPLICATION FORM
Santiago)
Friday,
2019 Aug 16,
T1H3IS:A0P0PL-ICA1TI4O:N0F0ORMISNOTFORSALE. PLEASEDONOTLEAVEANYSPACESBLANK,
INDICATEN/AIFNOTAPPLICABLE. PROVIDINGFALSE STATEMENTSINPASSPORTAPPLICATIONSISPUNISHABLEBYLAW(R.A. 8239).

TA_N_GI_L_AN JOSE
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN(Jr./II/III)
DE LE_ON PHILIPPINES /CAUAYAN CITY
MIDDLE NAME/ GITNANGPANGALAN PLACE OF BIRTH/ POOKNGKAPANGANAKAN

DECEMBER/ 22/ 1991 GENDER/ KASARIAN □ MALE□ FEMALE

MonthDayYear DATE OF BIRTH/ PETSANGKAPANGANAKAN (Ex.: March8, 2010)

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

Complete Address: P_A_N_A_G_A S_T_. B_A_R_A_N_G_A_Y_S_A_N F_E_R_M_I_N C_A_U_A_Y_A_N
C_I_T_Y_I_S_A_B_E_L_A_, C_A_U_A_Y_A… Tel. No.:
Present Occupation:T_E_A_C_H_I_N_G Mobile No.:+_6_3_9_1_7_3_8_3_9_4_0_6
Work Address: Tel. No.:
E-mail Address: J_O_S_E_T_A_N_G_U_I_L_A_N_2_2_@_G_MA_I_L_._C_O_M
Name of Wife / Husband: Citizenship:
Name of Father: A_L_E_X M_E_N_D_O_Z_A T_A_N_G_U_I_L_A_N Citizenship:P_H_L
Maiden/ Singlename of Mother:J_U_D_I_T_H C_O_N_C_E_P_C_I_ON D_E L_E_O_N
Citizenship:P_H_L
Citizenship Acquired By:
□
Birth □ Election □ Marriage □ Naturalization □ R.A. 9225 □ Others
□ □
Are youa holder of aforeign passport? □ Yes Have you ever been issued a Philippine Passport? □ Yes
No No
If Yes, fromwhat country? If Yes, latest Passport Number?
Date of issue: Place of issue:
(For applicants below18 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 amaware that under the
law, I amallowed to hold only one Philippine passport at any given time. 5) I amaware 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. JUDITH DE LEON/ +63936291440 .

FORUSEOFTHEDEPARTMENTOFFOREIGNAFFAIRSONLY. PLEASEDONOTWRITEBELOWTHISLINE.

REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer:

RECEIVEDCANCELLEDPASSPORT: RECEIVEDNEWPASSPORT:
FORADMINISTRATIVEUSEONLY:
E-Receipt No: For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph
1901645734
 Republic of the Philippines
DEPARTMENTOFFOREIGNAFFAIRS

ELECTRONIC RECEIPT NO. 1901645734

PAYMENT DETAILS:
MERCHANT: ECPA
BRANCH Y 71112434
REFERENCE
CODE: NO:
DATE:
DFAXYNIP7823-July-2019
TIME: 06:33:23 PM

APPOINTMENT NUMBER: 04252019081600027

NAME: JOSE DE LEON TANGILAN
SITE NAME: SANTIAGO, ISABELA (ROBINSONS PLACE SANTIAGO)
TRANSACTION: PASSPORT PROCESSING
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1901645734
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00
APPOINTMENT NUMBER: 04252019081600027
NAME: JOSE DE LEON TANGILAN
SITE NAME: SANTIAGO, ISABELA (ROBINSONS PLACE SANTIAGO)
TRANSACTION: PASSPORT PROCESSING
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1901645734
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00