Important Reminders

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Your appointment is on Wed, Jun 22, 2011 at 01:30 pm. Please be at DFA Aseana by 01:00 pm.

Please make sure you have prepared all the requirements. You can view the list at www.passport.com.ph

Please make sure to photocopy all of your requirements. Applicants without a complete set of photocopies will not be entertained.

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

You may have your passport delivered for extra convenience. Please prepare extra P120 for the delivery fee.

Please print this page and the application form on LONG BOND PAPER. Applicants without the printed application form will not be allowed entry at the DFA. Please complete the application form before going to the DFA.

For questions or concerns, you may email info@passport.com.ph. Thank you for using the DFA Passport Appointment System.

9225 Others: ________________________ AreThis serves as Affidavit of Support and Consent to Travel you a holder of a foreign passport? (for Applicants below 18 years old ONLY) No This serves as Affidavit of Support and ConsentYes to Travel Name of minor's (for Applicants below 18 years old ONLY) If Yes. from what country? ___________________ No Yes X Birth Election Marriage Naturalization If Yes. 2) The information I provided in thisSignature of true and correct. Signature of Parent or Legal Guardian Signature of Signature of Applicant Applicant IREMARKS:SWEAR that 1) I am a Filipino citizen. / II / III) Married GENDER Legally Separated / KASARIAN Widow/er Annulled Civil Married Widow/er Legally Separated Annulled Name of Wife / Husband: Status: X Single Citizenship: MIDDLE NAME / GITNANG PANGALAN PLACE OF BIRTH / POOK NG KAPANGANAKAN Name of Wife / Husband: BLOCK 3 LOT 11 MIRA VERDE HOMES. I am I SOLEMNLY SWEAR that 1) I am a Filipino citizen. I am REMARKS: allowed to hold only one Philippine passport at any given time. 5) I am aware that under the law. 3) The supporting Address / Contact Lost that in allowed to hold only one Philippine passport at any given time. from what country? ___________________ R. NONE GENDER / KASARIAN Mobile No: Work Address: Work Address: Civil Status: Single Married Widow/er Email Address: Office No: 0 JOHNPAULGALAG@YAHOO. Day/Month/Year) Civil Status: Single PLACE OF BIRTH / POOK NG KAPANGANAKAN GENDER / KASARIAN FIRST MALE NAME / PANGALAN (Jr. 6) I am aware due making false statements in passport application furnishing Number: documents attached are authentic. 2) The information I provided to: this application is true and correct.A. 4) I have not been issued a passport under any other name. ANTIPOLO RIZAL Citizenship: 09078049792 Complete Address: Tel.REPUBLIC OF THE PHILIPPINES DEPARTMENTOF THE PHILIPPINES REPUBLIC OF FOREIGN AFFAIRS DEPARTMENT MANILA OF FOREIGN AFFAIRS E-PASSPORT APPLICATION MANILA E-PASSPORT APPLICATION Wed. 4) I have not been issued a passport under any other name. No: Citizenship: Mobile No: Citizenship: Purpose of Travel: Tour Seaman Purpose of Travel: Study Work Seaman X Tour Study Work FILIPINO Business Migration Office No: Others: ______________ Business Migration Citizenship: Others: ______________ Citizenship: Have you ever been issued a Philippine Passport? Yes Have you ever been issued a Philippine Passport? No Purpose of Travel: If Yes. Day/Month/Year) MAY OF 1987 DATE OF BIRTH (Ex. No: Mobile No: 09078049792 NONE Present Occupation: Day/Month/Year) DATE OF BIRTH (Ex.COM Legally Separated Annulled Email of Wife / Name Address: Husband: Father: Maiden/Single Name Name of Father: Complete Address: of NONITO FULLERO GALAG Mother: Maiden/Single Name Present Occupation: of ANNIE ASUNCION ABERILLA Mother: Citizenship Acquired By: Work Address: Birth Election Marriage Naturalization Citizenship Acquired By: Email Address: R.9225 Others: Election ________________________ Marriage Naturalization X Birth Name of Father: R. / II / III) PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVECITY / POOK NG KAPANGANAKAN MIDDLE NAME / GITNANG PANGALAN PLACE OF BIRTH ABERILLA TAGUIG SPACES BLANK MIDDLE NAME / GITNANG PANGALAN DATE NAME / APELYIDO LAST 10. falsified or forged documents in support thereof are punishable by law. IMELDA M. BARANGAY SAN LUIS. Jun 22. 6) I am aware that making false statements in passport application furnishing falsified or forged documents in support thereof are punishable by law. 2011 01:30 NOT PLEASE PROVIDE CORRECT INFORMATION AND DO pm LEAVE SPACES BLANK REPUBLIC OF THE AND DO NOT PLEASE PROVIDE CORRECT INFORMATIONPHILIPPINES LEAVE SPACES BLANK DEPARTMENT OF FOREIGN AFFAIRS MANILA LAST NAME / APELYIDO FIRST PAUL GALAG JOHN NAME / PANGALAN (Jr. latest passport number? _______________ Issued by: Issued on: Date by: Issued of issue Datelost: Lost lost: Date due to: Lost due to: This serves Lost Passport Number: Issued on: ________ Place of issue _________ as Affidavit of Loss Issued by: Companion's Signature of Parent citizen. 2) The information I provided in this application is true and correct. latest passport number? _______________ Study Work Others: ______________ Date of issue ________ Place of issue _________ Date of issue ________ Place of issue _________ Have you ever been issuedAffidavit of Loss This serves as a Philippine Passport? Lost Passport Number: No This serves as Affidavit of Loss Yes Issued on: Lost Passport Number: If Yes.9225 Others: ________________________ Maiden/Single Name of Are you Mother: a holder of a foreign passport? Yes No Are you a holder of a foreign passport? Citizenship Acquired By: If Yes.A. Processor: Encoder: RECEIVED Processor: CANCELLED PASSPORT:Encoder: REMARKS: RECEIVED CANCELLED PASSPORT: FOR ADMINISTRATIVE USE ONLY: Signing Officer: RECEIVED NEW PASSPORT: Signing Officer: Signature of Applicant RECEIVED NEW PASSPORT: FOR ADMINISTRATIVE USE Please print name and affix initials. 5) I am aware that under the law. 5) I am aware that under the law. STRICT COMPLIANCE: ONLY: Processor: Encoder: Signing Officer: RECEIVED NEW PASSPORT: RECEIVED CANCELLED PASSPORT: FOR ADMINISTRATIVE USE ONLY: . No: Complete Address: Present Occupation: Tel. allowed to hold only one Philippine passport at any given time. I am falsified or forged documents in support thereof are punishable by law. QUIMNO.A. FOR STRICT COMPLIANCE: Please print name and affix initials. latest passport number? _______________ No Yes X Tour Seaman Business Migration If Yes. 3) The supporting SOLEMNLY application is Applicant documents attached are authentic. / II / III) E-PASSPORT APPLICATION LAST NAME / APELYIDO FIRST NAME / PANGALAN (Jr. 3) The supporting Signature of Applicant I SOLEMNLY SWEAR that 1) I am a Filipino or Legal Guardian Date lost: Relationship: of Parent or Legal Guardian Signature of Applicant documents attached are authentic. 6) I am aware that making false statements in passport application furnishing FOR STRICT COMPLIANCE: Please print name and affix initials. 4) I have not been issued a passport under any other name. BIRTH (Ex. from what traveling companion: country? ___________________ Name of minor's Companion's traveling companion: Relationship: Companion's Address / Contact Relationship: Number: Address / serves as Affidavit of Support and Consent to Travel This Contact Number: (for Applicants below 18 years old ONLY) Name of minor's traveling companion: Signature Office No: Citizenship: Citizenship: FILIPINO Tel.