REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE

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NATIONAL BUREAU OF INVESTIGATION
REFERENCE NUMBER
NBI CLEARANCE APPLICATION
FORM MP581TUXDA
Wednesday Nov 15, 2023 AM ()
Valid Until Nov 30, 2023

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

NEW DRIVERSLIC|B09-19-002301 LOCAL MULTI-PURPOSE CLEARANCE
BASIC INFORMATION
5. FAMILY NAME 6. HUSBAND FAMILY NAME (FOR MARRIED WOMAN ONLY)
LAMUAS -

7. GIVEN NAME 8. MIDDLE NAME

RHEA LYN DATUIN

9. NICKNAME 10. OTHER NAME/ALSO KNOW AS

IYA -

11. DATE OF BIRTH 12. BIRTH PLACE

01/04/2000 BURGOS ISABELA

13. CITIZENSHIP 14. GENDER 15. CIVIL STATUS

FILIPINO FEMALE SINGLE

16. SPOUSE 17. BIRTH PLACE

- -

18. PRESENT ADDRESS

CATABBAN BURGOS ISABELA

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

09928969965 datuinrhealyn@gmail.com -
ADDITIONAL INFORMATION
22. HEIGHT 23. WEIGHT 24. COMPLEXION 25. RELIGION
150 60 BROWN CHRISTIAN

26. EDUCATIONAL ATTAINMENT 27. OCCUPATION

COLLEGE GRADUATE NA
PARENTS INFORMATION
28. NAME OF FATHER 29. FATHER BIRTH PLACE
ALEXANDER LAMUAS BURGOS ISABELA

30. NAME OF MOTHER 31. MOTHER BIRTH PLACE

REYNALYN LAMUAS BURGOS ISABELA

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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