E-Passport Application Form - Philippine Embassy
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1REPUBLIC 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 STATEMENT IS PUNISHABLE BY LAW (R.A. 8239)
Foreign Service Post:
BERNE
GENEVA
LAST NAME
PLACE OF BIRTH
FIRST NAME
DATE OF BIRTH
(Ex. 01 January 2012)
MIDDLE NAME
GENDER:
Female
Male
CIVIL STATUS
Single
Married
Annulled
Widow/er
Divorced
Legally Separated
APPLICANT'S SPOUSE
CITIZENSHIP
(First-Middle-Last Name)
APPLICANT'S FATHER
CITIZENSHIP
(First-Middle-Last Name)
APPLICANT'S MOTHER
CITIZENSHIP
(First-Middle-Last Name)
ADDRESS in CH
MOBILE # in CH
TEL. NO.
OCCUPATION
EMAIL ADDRESS
WORK ADDRESS
ADDRESS in PHILIPPINES
CONTACT # in PHILIPPINES
Birth
Election
Naturalization
Citizenship Acquired By:
Marriage
Dual Citizenship
Others
Have you ever been issued a Philippine Passport?
Are you a holder of a foreign passport?
If Yes, Latest Passport Number: _________________
Yes
No
Date of Issue: ___________Place of Issue: __________
If Yes, from which country? __________________
(for Applicants below 18 years old ONLY)
(for Replacement of Lost Passport ONLY)
Name of minor's travelling companion:____________
Lost Passport Number: __________________________
Companion's Relationship: _____________________
Issued on: ______________ Issued by: _____________
Address: ___________________________________
Contact Number of Companion: _________________
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 GENERAL OF THE REPUBLIC OF THE PHILIPPINES
Processor:
Encoder:
Signing Officer:
Received Cancelled Passport:
Received New Passport:
Remarks:
Date: _______________
Service No.: _________
O.R. No.: ___________
Fee Paid: ___________
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