REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE


NATIONAL BUREAU OF INVESTIGATION
REFERENCE NUMBER
NBI CLEARANCE APPLICATION
FORM MP8P3B5JDV
Tuesday Sep 12, 2023 AM ()
Valid Until Sep 27, 2023

APPLICANT TYPE 1. ID PRESENTED 2. PURPOSE TYPE 3. PURPOSE APPLICATION

NEW PASSPORT|X6788207 LOCAL MULTI-PURPOSE CLEARANCE
BASIC INFORMATION
5. FAMILY NAME 6. HUSBAND FAMILY NAME (FOR MARRIED WOMAN ONLY)
YANGNI ANGATE KACOU

7. GIVEN NAME 8. MIDDLE NAME

KEVA MELAINE MARIE AMOUZOUA

9. NICKNAME 10. OTHER NAME/ALSO KNOW AS

- -

11. DATE OF BIRTH 12. BIRTH PLACE

01/07/1991 ABIDJAN COTE D’IVOIRE

13. CITIZENSHIP 14. GENDER 15. CIVIL STATUS

SWISS FEMALE MARRIED

16. SPOUSE 17. BIRTH PLACE

JEAN FRANCOIS ABIDJAN

18. PRESENT ADDRESS

MONTREAL

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

09264654265 angate.keva@gmail.com MNU
ADDITIONAL INFORMATION
22. HEIGHT 23. WEIGHT 25. RELIGION
24. COMPLEXION
169 69 CHRISTIAN
FAIR

26. EDUCATIONAL ATTAINMENT 27. OCCUPATION

MASTERAL COACH
PARENTS INFORMATION
28. NAME OF FATHER 29. FATHER BIRTH PLACE
FRANCOIS ABIDJAN

30. NAME OF MOTHER 31. MOTHER BIRTH PLACE

YVETTE ABIDJAN
FOREIGN INFORMATION
32. FOREIGN NAME 33. FOREIGN ADDRESS
MNU 6131 AVENUE GERARD MORISSET H1M3J8 MONTREAL

34. PASSPORT NO 35. DATE ISSUED

X6788207 1970-01-01 00:00:00

34. ISSUED AT 35. ACR NUMBER

DFAE BERNE MNU

34. DATE ISSUED 35. ISSUED AT

1970-01-01 00:00:00 MNU
:
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

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