Passport Application Form (Fa Form No. 79) - Philippine Embassy
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Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
Post: Philippine Embassy Kuala Lumpur
PASSPORT APPLICATION FORM (FA FORM NO. 79)
This application form is not for sale.
Please do not leave any spaces blank. Indicate N/A if not applicable.
Providing false statements in this passport application is punishable by law (R.A No. 8239).
LAST NAME / APELYIDO
FIRST NAME / PANGALAN
PLACE OF BIRTH / POOK NG KAPANGANAKAN
MIDDLE NAME / GITNANG PANGALAN
__________________ / _________ / ___________
Month
Day
Year
[
] Male
[
] Female
DATE OF BIRTH / PETSA NG KAPANGANAKAN
GENDER / KASARIAN
( e.g., April / 25 / 2014 )
Civil Status: [ ] Single
[ ] Married
[ ] Widow/er
[ ] Legally Separated
[ ] Annulled
[ ] Divorced
Complete Address in the Philippines _________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
Present Occupation________________________________________________________________________
Work Address in the Philippines or Abroad____________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
SSS No. ___________________ OWWA Membership ID No. (if any)_________________________________
Tax Identification No. (TIN) _________ Overseas Employment Certificate (OEC) No. (if any) _______________
Driver’s License No. _______________________ Pag-IBIG ID No. ___________________________________
PHILHEALTH ID No. ______________________ Community Tax Certificate (CEDULA) No. _______________
Name of Wife / Husband _________________________________________ Citizenship _________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________
Mobile No. ____________________ Email _______________________
Name of Father _________________________________________________ Citizenship ________________
Maiden / Single Name of Mother ____________________________________ Citizenship________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________
Mobile No. ____________________ Email _______________________
In case of emergency, name of Next-of-Kin (NOK) to be contacted: __________________________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________
Mobile No. ____________________ Email _______________________
Citizenship Acquired By:
[ ] Birth [ ] Election [ ] Marriage [ ] Naturalization [ ] R.A. 9225 [ ] Others ___________________
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