E-Passport Application Form
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REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF FOREIGN AFFAIRS
NOT FOR SALE
PHILIPPINE EMBASSY CANBERRA
PHILIPPINE CONSULATE GENERAL SYDNEY
E-PASSPORT APPLICATION FORM
PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK
LAST NAME / APELYIDO
FIRST NAME / PANGALAN (JR./II/III)
MIDDLE NAME / GITNANG PANGALAN
PLACE OF BIRTH / POOK NG KAPANGANAKAN
/
/
GENDER/KASARIAN :
_____MALE
_______ FEMALE
MONTH
DAY
YEAR
DATE OF BIRTH / ARAW NG KAPANGANAKAN
Civil Status:
______Single
_____Married
_____Widow/er
____Legally Separated
______Annulled
Complete Home Address: _____________________________________________________________________________________
Present Occupation: ______________________________ Tel No. ______________ Mobile No.______________________________
Work Address: ___________________________________________
Email Add: _____________________________________
Name Of Father: _____________________________________________________________
Citizenship: ___________________
First Name
Middle Name
Last Name
Maiden/Single
Name Of Mother:_____________________________________________________________
Citizenship: ___________________
First Name
Middle Name
Last Name
Name Of Wife/Husband: ______________________________________________________
Citizenship: ___________________
First Name
Middle Name
Last Name
Citizenship Acquired By:
Are You A Holder of a
foreign passport?
_____ Yes ______ No
____ Birth ____ Election ____ Marriage
____ RA9225
If Yes, From What Country? ______________________
_____Naturalization
Others: ________________
THIS SERVES AS AN AFFIDAVIT OF SUPPORT AND CONSENT TO TRAVEL
(for applicants below 18 years old ONLY)
Name of minor’s traveling companion: ______________________________Companion’s Relationship: ______________________
Address/Contact Details:
_______________________________
_________________________________
Signature of Parent/Legal Guardian
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
furnishing falsified or forged documents in support thereof are punishable by law.
OR No.:_____________
Signature of Applicant
SRV No.:____________
(to be signed at the Embassy / Consulate)
RECEIVED CANCELLED PASSPORT:
_________________________________
PROCESSOR: ________________
Signature / Date
RECEIVED NEW PASSPORT:
_________________________________
ENCODER: ___________________
Signature / Date
SIGNING OFFICER: ____________
RETURNED OLD PASSPORT TO APPLICANT:_________________________________
Signature / Date
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