Fa Form No. 40 - Report Of Birth - Child Born Abroad Of Filipino Parent/s

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NOT FOR SALE
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF FOREIGN AFFAIRS
FA FORM NO. 40
(REVISED JUNE 2013)
DATE OF REPORT
REPORT OF BIRTH
(day-month-year)
CHILD BORN ABROAD OF FILIPINO PARENT/S
THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE
Foreign Service Post:
DETAILS OF CHILDS BIRTH
1. CHILD'S LAST NAME
5. DATE OF BIRTH
(day-month-year)
2. CHILD'S FIRST NAME
6. TIME OF BIRTH
[ ] AM
[ ] PM
3. CHILD'S MIDDLE NAME
7. SEX
[ ] MALE
[ ] FEMALE
4. PLACE OF BIRTH
8. CIVIL STATUS OF PARENTS [ ] MARRIED [ ] NOT MARRIED
DETAILS OF BIRTH PARENTS ( at the time of child's birth)
INFORMATION ON BIRTH FATHER
INFORMATION ON BIRTH MOTHER
9. LAST NAME
10. FIRST NAME
11. MIDDLE NAME
12. NAME BEFORE MARRIAGE
13. CITIZENSHIP
14. DATE OF BIRTH
(day-month-year)
15. PLACE OF BIRTH
16. OCCUPATION
17. RELIGION
18. HOME ADDRESS
19. NATURALIZED (if foreign born)
20. DATE & PLACE OF REGISTRATION
AS PHILIPPINE CITIZEN
(day-month-year/country)
21. DATE OF MARRIAGE
24. PLACE OF MARRIAGE
(day-month-year)
22. NUMBER OF PREVIOUS CHILDREN
25. NUMBER OF CHILDREN NOW LIVING
23. SIGNATURE OF PARENT, PHYSICIAN OR NURSE OVER PRINTED NAME
WHEN REPORTED BY MAIL, USE THIS PORTION IN THE PRESENCE OF TWO WITNESSES:
WHEN REPORTED IN PERSON, USE THIS PORTION:
Subscribed and sworn to before me this _______ day of
Declared in our presence this _____ day of _________________ at _________________.
___________________ at the Embassy/Consulate of the
First Witness: _____________________________________________________________
Philippines in _________________________________.
Address: _________________________________________________________________
Second Witness: __________________________________________________________
Address: _________________________________________________________________
SEAL
REPUBLIC OF THE PHILIPPINES
EMBASSY/CONSULATE OF THE REPUBLIC OF THE PHILIPPINES
The foregoing information was furnished by (father, mother, physician, nurse) and supported by (affidavit, physician's certificate, certificate from
local authorities). This report has been executed in quadruplicate, copy issued to parents, copy transmitted to the Department of Foreign Affairs
(DFA) in Manila, copy transmitted to the Civil Registrar General through the DFA and copy placed in the files of this Office.
Date : _____________________
Doc. No. ___________________
Service No. _________________
O.R. No. ____________________
Fee Paid ___________________
Book No. ___________________
SEAL
REPUBLIC OF THE PHILIPPINES
Series of ___________________

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