9/8/23, 9:56 AM NBI CLEARANCE

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE
NATIONAL BUREAU OF INVESTIGATION

NBI CLEARANCE APPLICATION

 REFERENCE NUMBER

FORM FRR9VHFOKK
Tuesday Sep 05, 2023 PM ()
Valid Until Sep 20, 2023
APPLICANT TYPE 1. ID PRESENTED 2. PURPOSE TYPE 3. PURPOSE APPLICATION
NEW PASSPORT| P6431905B LOCAL MULTI-PURPOSE CLEARANCE

BASIC INFORMATION

5. FAMILY NAME 6. HUSBAND FAMILY NAME (FOR MARRIED WOMAN ONLY)

CABUSO -

7. GIVEN NAME 8. MIDDLE NAME

CHARLES DALE MERCADO

9. NICKNAME 10. OTHER NAME/ALSO KNOW AS

- -

11. DATE OF BIRTH 12. BIRTH PLACE

07/23/2001 SAN FERNANDO

13. CITIZENSHIP 14. GENDER 15. CIVIL STATUS

FILIPINO MALE SINGLE

16. SPOUSE 17. BIRTH PLACE

- -

18. PRESENT ADDRESS

BLK 133 LOT 25 BULAON RESETTLEMENT

19. CONTACT NUMBER 20. EMAIL ADDRESS 21. IDENTIFYING MARKS

09498534598 charlesdalecabuso12@gmail.com BIRTHMARK ON LEFT WAIST
ADDITIONAL INFORMATION

22. HEIGHT 23. WEIGHT 24. COMPLEXION 25. RELIGION

183 86 BROWN ROMAN CATHOLIC

26. EDUCATIONAL ATTAINMENT 27. OCCUPATION

COLLEGE LEVEL UNEMPLOYED

PARENTS INFORMATION
28. NAME OF FATHER 29. FATHER BIRTH PLACE
CHRISTOPHER CALILUNG CABUSO TARLAC

30. NAME OF MOTHER 31. MOTHER BIRTH PLACE

SHERYL MERCADO CABUSO BACOLOR

I certify that I have read and understood all the questions set forth in this application and answer I have furnished on this form are true and correct to the best acknowledge and belief. I understand that any false or
misleading statement is FALSIFICATION PUNISHABLE UNDER ARTICLE 171 & 172 OR REVISED PENAL CODE

________________________________ ________________________________

36. DATE 37. SIGNATURE

© 2015 All Rights Reserved

https://firsttimejobseekers.nbi.gov.ph/print 1/1