NOT FOR SALE
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF FOREIGN AFFAIRS
Notes:
E- PASSPORT APPLICATION
THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE.
PROVIDING FALSE STATEMENTS IS PUNISHABLE BY LAW (R.A. 8239).
Foreign Service Post:
LAST NAME
PLACE OF BIRTH
FIRST NAME
DATE OF BIRTH
(Ex. 01 January 2012)
MIDDLE NAME
Female
Male
GENDER:
:
CIVIL STATUS
Single
Married
Annulled
Widow/er
Legally Separated
NAME OF SPOUSE
CITIZENSHIP
(First-Middle-Last Name)
ADDRESS ABROAD
CONTACT # ABROAD
EMAIL ADDRESS
CONTACT # in PHILIPPINES
ADDRESS in PHILIPPINES
OCCUPATION
WORK ADDRESS
CONTACT #
NAME OF FATHER
CITIZENSHIP
(First-Middle-Last Name)
MAIDEN NAME OF MOTHER
CITIZENSHIP
(First-Middle-Last Name)
Birth
Dual Citizenship
Others
Work
Tour
Marriage
Naturalization
Purpose of Travel:
Seafarer
Study
Citizenship Acquired By:
Election
Others
Migration
Business
Have you ever been issued a Philippine Passport?
Yes
No
Are you a holder of a foreign passport?
No
Yes
If Yes, Latest Passport Number:
If Yes, from which country?
Date of Issue:
Place of Issue:
This serves as an Affidavit of Loss
This serves as Affidavit of Support and Consent to Travel
Lost Passport Number:
(for Applicants below 18 years old ONLY)
Issued on:
Issued by:
Name of minor's traveling companion:
Companion's Relationship:
Date Lost:
Address/ Contact Number:
Lost due to:
Signature of Parent or Legal Guardian:
Signature of Applicant:
I SOLEMNLY SWEAR that: 1) I am a Filipino Citizen; 2) The information I provided in this application are true and correct; 3) The supporting documents
attached are authentic; 4) I have not been issued a passport under any other name; 5) I am aware that under the law, I am allowed to hold only one
passport at any given time; 6) I am aware that making false statements and furnishing falsified or forged documents are punishable by law.
Signature Over Printed Name of Applicant
EMBASSY/ CONSULATE OF THE REPUBLIC OF THE PHILIPPINES
Encoder:
Signing Officer:
Processor:
Date: __________________________
Received New Passport:
Received Cancelled Passport:
Service No.: _____________________
O.R. No.:________________________
Fee Paid: _______________________
Remarks: