WRITE LEGIBLY IN BLOCK CAPITAL CLEARANCE PROCESSING CENTER:

LETTERS Republic of the Philippines

(ISULAT SA PAMAMAGITAN NG Department of Justice BRANCH:
NATIONAL BUREAU OF INVESTIGATION
MALALAKING TITIK ANG MGA SAGOT)
FALSIFICATION PUNISHABLE UNDER ART. 171 & 172 OF THE REVISED
NBI Biometric Clearance System (NBCS)
DATE:
PENAL CODE
CLEARANCE APPLICATION FORM
O* R NUMBER:
(FOR CASHIER’S USE
ONLY)
ID CIVIL
PRESENTED: SEX:
(Indicate ID
STATUS: CITIZENSHIP
Number)
SCARS / MARKS / PECULIARITIES:
PURPOSE: COMPLEXION RELIGION

LAST NAME: HEIGHT WEIGHT

ft OR cm lbs OR Kg
HUSBAND’S SURNAME NAME OF Husband or Wife PLACE OF BIRTH(INDICATE TOWN/CITY,
PROVINCE)
FOR MARRIED WOMAN:
NAME OF FATHER PLACE OF BIRTH(INDICATE TOWN/CITY,
FIRST NAME: PROVINCE)

NAME OF MOTHER (Maiden Name) PLACE OF BIRTH(INDICATE TOWN/CITY,

MIDDLE NAME: PROVINCE)

NICKNAME:
APPLICANT IS ALIEN (PLEASE CHECK IF APPLICABLE AND FILL UP BELOW)
OTHER NAME / AKA: PASSPORT or ACR
PRESENT ADDRESS: NAME:
ADDRESS
ABROAD:
DATE OF PLACE PASSPORT NUMBER: DATE PLACE
BIRTH: MONTH DATE YEAR OF BIRTH (INDICATE TOWN/CITY, PROVINCE) ISSUED ISSUED
HIGHEST ACR NUMBER: DATE PLACE
OCCUPATION
EDUCATIONAL ATTAINMENT ISSUED ISSUED

THIS FORM IS NOT FOR SALE

CONTACT
NUMBER / S
e-MAIL
ADDRESS
SUNDRY INFORMATION I HEREBY CERTIFY THAT THE FOREGOING
 STATEMENTS ARE TRUE AND CORRECT
FOR NBI USE ONLY REMARKS FALSIFICATION PUNISHABLE UNDER ART. 171 & 172 OF THE REVISED PENAL CODE

R/C: Q/C:
FN: Revised NBI Clearance Application Form V1.7 SIGNATURE OF APPLICANT