E-Passport Application - Philippine Embassy In London
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EMBASSY OF THE PHILIPPINES
6-8 SUFFOLK STREET
LONDON SW1Y 4HG
UNITED KINGDOM
E-PASSPORT APPLICATION
PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK
______________________________________________________
_______________ / _________________________ / ___________
LAST NAME / APELYIDO
Day
Month
Year
DATE OF BIRTH / PETSA NG KAPANGANAKAN
(Ex. 01 January 2013)
______________________________________________________
FIRST NAME / PANGALAN (Jr. / II / III)
______________________________________________________
PLACE OF BIRTH / POOK NG KAPANGANAKAN
______________________________________________________
MIDDLE NAME / GITNANG PANGALAN
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GENDER / KASARIAN:
MALE
FEMALE
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Single
Married
Widow/er
Legally Separated
Annulled
Divorced
Civil Status:
Name of Wife / Husband: _______________________________________________
Citizenship: _______________________
First Name
Middle Name
Last Name
Complete U.K. Address: ____________________________________________________________
______________________
Tel. No.:
Present Occupation: _______________________________________________________________
Mobile No.: ______________________
Work Address : _______________________________________________________________________________________________________
E-mail Address: __________________________________________________________________
Tel. No.( at work): ________________
Name of Father: _________________________________________________________________
Citizenship: ______________________
First Name
Middle Name
Last Name
Maiden/Single
Name of Mother : _________________________________________________________________
Citizenship: ______________________
First Name
Middle Name
Last Name
Contact Person and his/her address in the Philippines (in case of emergency
) ___________________________________________________________________________________
_____________________________________________________________________________________________________________________
Philippine Citizenship Acquired By:
Immigration Status in the U.K.:
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Birth
Election
Marriage
Naturalization
Visitor
Seaman
Business
Resident
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_________________
R.A. 9225
Others
Student
Work Permit
Others _______________
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Yes
No
Are you a citizen of another country?
Yes
No
Have you ever been issued a Philippine Passport?
If yes, Latest Passport Number? ____________________________
If yes, from what country? _____________________
Date of Issue: _____________
Place of Issue: ______________
This serves as an Affidavit of Support and Consent to Travel
This serves as an Affidavit of Loss
(for Applicants below 18 years old ONLY)
Name of Minor’s traveling
Lost Passport Number:
_________________________________________
Companion:
________________________________________
Issued on: _____________________Issued By: _________________________
Companion’s Relationship: _________________________________________
Address/Contact
Date Lost: _______________________________________________________
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 is 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 Philippine passport at any given time. 6) I am aware that making
false statements in passport application and furnishing falsified or forged documents in support thereof are punishable by law.
__________________________________________________
Signature of Applicant (parents to sign for minor children)
REMARKS:
FOR STRICT COMPLIANCE:
Please print name and affix initials.
Processor:
Encoder:
Signing Officer:
RECEIVED OLD/CANCELLED PASSPORT:
RECEIVED NEW PASSPORT:
FOR ADMINISTRATIVE USE ONLY:
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