Passport Application Form printable pdf download

Republic of the Philippines

DEPARTMENT OF FOREIGN AFFAIRS

Post: JAKARTA PE

PASSPORT APPLICATION FORM (FA FORM NO. 79)

PLEASE DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE

PROVIDING FALSE STATEMENTS IN PASSPORT APPLICATION IS PUNISHABLE BY LAW (RA NO. 8239)

_______________________________________

___________________________________________________

Last Name/Apelyido

LAST NAME / Apelyido

FIRST NAME / Pangalan (Jr.) / II /III

________________________________________

___________________________________________________

MIDDLE NAME / Gitnang Pangalan

PLACE OF BIRTH / Pook ng Kapanganakan

_________________________________________

GENDER

MALE

FEMALE

Month

/ Day /

Year

DATE OF BIRTH / Petsa ng Kapanganakan

[ ] Single [ ] Married [ ] Widow/er [ ] Legally Separated [ ] Annulled [ ] Divorced

Civil Status

Complete Address in the Philippines __________________________________________________________________

___________________________________________________________ Abroad : ____________________________

__________________________________________________________________________________________

Tel No_______________ Mobile No. ______________________ E-mail Address: ________________________

Present Occupation __________________________ Employer: ___________________________________________

Work Address in Philippines or Abroad _______________________________________________________________

____________________________________________________________________________________________________

Tel No. ______________ Fax No.: _______________________ E-mail Address _______________________________

SSS No.______________________ _ OWWA Membership ID No. ____________________________________ (If any)

Tax ID No. (TIN) _______________ Overseas Employment Certificate (OEC) No.

(If any)

________________________

Driver’s License No. __________________________ PAG-IBIG ID No. ________________________________

PHILHEALTH ID No. _______________________ Community Tax Cert. (

. ___________________

CEDULA) No

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Name of Wife / Husband : __________________________________________ Citizenship ________________

Complete Address in the Philippines or Abroad _________________________________________________

__________________________________________________________________________________________

Tel. No. _______________ Mobile No. ___________________ E-mail Address ________________________

‘-

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Name of Father: _________________________________________________ Citizenship _________________

Maiden / Single Name of Mother ____________________________________ Citizenship_________________

Complete Address in the Philippines __________________________________________________________

__________________________________________________________________________________________

Tel No.________________ Mobile No.______________________ E-mail Address_______________________

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In case of emergency, name of next-of-kin (NOK) to be contacted: __________________________________

Complete Address in the Philippines ___________________________________________________________

__________________________________________________________________________________________

Tel No. ________________ Mobile No. ____________________ E-mail Address ________________________

CITIZENSHIP ACQUIRED BY: [ ] Birth [ ] Election [ ] Marriage [ ] Naturalization

[ ] RA 9225

[ ] Others: _______________________

Passport Application Form

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