Fa Form No.40 - Report Of Birth - Embassy Of The Philippines In Seoul, Korea
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1NOT FOR SALE
REPUBLIC OF THE PHILIPPINES
FA FORM NO.40
DEPARTMENT OF FOREIGN AFFAIRS
(REVISED MARCH 2013)
REPORT OF BIRTH
DATE OF REPORT
CHILD BORN ABROAD OF FILIPINO PARENT/S
(day-month-year)
THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE.
ID#
Foreign Service Post:
DETAILS OF CHILD'S BIRTH
5. DATE OF BIRTH
1. CHILD'S LAST NAME
(day-month-year)
2. CHILD'S FIRST NAME
AM
PM
6. TIME OF BIRTH
3. CHILD'S MIDDLE NAME
7. SEX:
FEMALE
MALE
4. PLACE OF BIRTH
:
8. CIVIL STATUS OF PARENTS
MARRIED
NOT MARRIED
DETAILS OF PARENTS (at the time of child's birth)
INFORMATION ON CHILD'S FATHER
INFORMATION ON CHILD'S MOTHER
9. LAST NAME
10. FIRST NAME
11. MIDDLE NAME
12. MAIDEN SURNAME
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/ place of registration)
21. DATE OF MARRIAGE
24. PLACE OF MARRIAGE
(day-month-year)
22. NUMBER OF PREVIOUS CHILDREN
25. NUMBER OF CHILDREN NOW LIVING
23. SIGNATURE OVER PRINTED NAME & ADDRESS OF PARENT/S, PHYSICIAN OR NURSE
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
of
the
Philippines
in
Seoul, South Korea.
First Witness:
__________________________________________________
Address:
__________________________________________________
Second Witness:
__________________________________________________
Address:
__________________________________________________
SEAL
REPUBLIC OF THE PHILIPPINES
EMBASSY OF THE REPUBLIC OF THE PHILIPPINES IN SEOUL, SOUTH KOREA
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: __________________________
Service No.:_______________, O.R. No.: ______________________
Doc. No.: ___________Book No.: ___________ Series of ________
SEAL
REPUBLIC OF THE PHILIPPINES
Fee Paid: _______________________
:________________________________
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