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    New Regular Passport Application (Adult)

    Uploaded by

    Tata Kate

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    New Regular Passport Application (Adult)

    Uploaded by

    Tata Kate
    3 views2 pages

    Original Title

    00002023022702375

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    © © All Rights Reserved

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    3 views2 pages

    New Regular Passport Application (Adult)

    Uploaded by

    Tata Kate

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Form no.

    1- ENGLISH
    NEW REGULAR PASSPORT APPLICATION (Adult)
    THIS FORM IS NOT FOR SALE
    DEPARTMENT OF FOREIGN AFFAIRS
    Office of Consular Affairs Last Revision: 07 October 2017
    INSTRUCTIONS: Please PRINT entries legibly using black or blue ink only. Supply
    the necessary informa on and indicate “N/A” for entries with no answers.
    Check boxes as appropriate.

    CAPTURE SITE PRE-PROCESSING (Do not write on this part)


    APPOINTMENT VERIFICATION: REMARKS:

    PASSPORT APPLICANT'S INFORMATION


    1. LAST NAME Diaz
    2. FIRST NAME Kiethdale
    3. MIDDLE NAME OR MAIDEN LAST NAME Bito-on
    4. GENDER 5. DATE OF BIRTH (EX. 01 JAN 2017) 6. PLACE OF BIRTH
    MALE 04-Oct-1990 MALAY AKLAN
    FEMALE
    7. CIVIL 8A. HOW DID YOU ACQUIRE PHL 8B. DID YOU EVER LOSE YOUR PH
    STATUS CITIZENSHIP? CITIZENSHIP? YES NO
    SINGLE BY BIRTH 8C. ARE YOU CURRENTLY A CITIZEN OF
    MARRIED BY NATURALIZATION ANOTHER COUNTRY? YES NO
    BY RE-ACQUISITION(RA NO. 9225) 8D. IF YES, FROM WHAT COUNTRY?
    WIDOW/ER BY ELECTION 8E. HAVE YOU SERVED IN ANY FOREIGN
    ANNULLED BY LEGISLATION MILITARY? YES NO
    DIVORCED BY MARRIAGE 8D. IF YES, WHAT COUNTRY?

    APPLICANT'S CONTACT INFORMATION


    9A. ADDRESS ABROAD
    PHILIPPINES
    9B. ADDRESS IN THE PHILIPPINES
    BLK 2 LT 7 AUSTERY SUBDIVISION PALE MANDURRIAO, ILOILO 5000, PHILIPPINES
    10. TELEPHONE/MOBILE NUMBER 09999984017
    11. EMAIL ADDRESS [email protected]
    12. APPLICANT'S SPOUSE'S NAME: Diaz, Neil Vincent Palacios
    13A. PERSON TO CONTACT IN CASE OF EMERGENCY: Concepcion, Annabelle Mallo
    13B. TEL/MOBILE NO.: (0966) 734 7339
    PARENTAL INFORMATION
    14. FATHER'S DETAILS 15. MOTHER'S DETAILS
    LAST NAME: Bito-on LAST NAME: Mallo
    FIRST NAME: Cesar FIRST NAME: Annabelle
    MIDDLE NAME: Candari MIDDLE NAME: Lucero
    CITIZENSHIP: (at time of applicant's birth) CITIZENSHIP: (at time of applicant's birth)
    Philippines Philippines
    DECLARATION OF APPLICANT
    I HEREBY DECLARE AND AFFIRM that 1) I am a Filipino citizen. 2) The information provided in
    this application is true and correct. 3) The supporting documents attached are authentic. 4)
    I consent to the verification by the Philippine Government of the information I provided to
    establish my personal particulars, and further consent to its use for any lawful purpose. 5)
    I am aware that the information provided in this application will be treated in accordance
    with relevant privacy regulations. 6) I am aware that under the law, I am allowed to hold
    only one valid regular Philippine passport at a given time. 7) I am aware that making false
    statements in this passport application and furnishing falsified or forged documents are
    punishable by fine or imprisonment, and grounds for suspension or denial of application. 8) I
    understand and accept that the release of the passport could be subject to delay due to
    unforeseen events beyond the control of the Department of Foreign Affairs.

    17. SIGNATURE OVER PRINTED NAME 18. DATE (EX. 01 JAN 2017)
    DO NOT WRITE BELOW THIS LINE. FOR THE DEPARTMENT’S USE ONLY.
    PROOF OF PHL CITIZENSHIP IDENTITY DOCUMENT SUPPORTING DOCUMENTS
    BIRTH CERTIFICATE FROM PHL SUBMITTED MARRIAGE CERTIFICATE FROM
    STATISTICS AUTHORITY COMELEC VOTER'S ID PHL STATISTICS AUTHORITY
    CERTIFICATE OF LTO DRIVER'S LICENSE VOTER'S REGISTRATION
    NATURALIZATION PROFESSIONAL REGULATORY RECORD
    IDENTIFICATION CERTIFICATE COMMISSION ID COURT ORDER
    OF CITIZENSHIP UNIFIED MULTIPURPOSE ID NBI CLEARANCE
    ELECTION OF PHL CITIZENSHIP (UMID) OTHERS:
    OTHERS: PWD ID
    GSIS / SSS ID
    SENIOR CITIZEN'S ID
    OTHERS:

    REMARKS: PASSPORT WATCHLIST VERIFICATION:

    PROCESSOR'S SIGNATURE: ENCODER'S SIGNATURE:

    OFFICIAL RECEIPT/PAYMENT SLIP NO.: DATE OF TRANSACTION:

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