DFA-OCA-PDO-45

REV. 02/JUN. 2019

PASSPORT REQUEST FORM

Date

APPLICANT'S DETAILS

LAST FIRST NAME MIDDLE NAME

Contact No. :
PHL ABROAD
E-mail Address:

ASSISTANCE REQUESTED

TRANSFER OF RELEASE TO FSP/CO CLAIM BY CANCELLATION OF PPT # ______________________

PULL - OUT REPRESENTATIVE WITH SUSPENDED APPLICATION
RETURN TO OCA IN _________________________________________

Place of Application: Status:

Date of Application:
Releasing Site:
(For transfer of release)

(For claims by representative)

Relation to the applicant: Contact No. :

PLEASE STATE FACTS AND REASON/S FOR REQUEST:

REMINDERS:
1. Prepare this document in two (2) copies: DFA's copy and applicant's copy.

2. Applicants must immediately inform the nearest FSP/CO upon arrival.

3. Representatives must present a notarized Special Power of Attorney.

4. Transfer of release may be availed of once only.

5. Request for transfer release may take time depending on the schedule of arrival of pouch from Foreign Service Posts/Consular Offices.

6. The Department reserves the right to deny the request subject to existing laws, rules and regulations.

7. I have understood the above reminders.

I hereby certify that the above information is correct.

_____________________________
Applicant's Signature
Case Officer:

Department of Foreign Affairs - Office of Consular Affairs

Bradco Avenue corner Macapagal Boulevard
Aseana Business Park, Barangay Tambo
Parañaque City, Philippines
Email address: passportconcerns@dfa.gov.ph
556-0000