Application Form Citizenship Retention And Re-Acquisition Form - Republic Of The Philippines - Embassy Of The Philippines, Seoul, South Korea

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Republic of the Philippines
Embassy of the Philippines, Seoul, South Korea
Seoul, South Korea
)
______________________) S.S.
Docket No. ROK-
- 14
x----------------------------------------------x
PETITION FOR RETENTION AND/OR RE-ACQUISITION OF
PHILIPPINE CITIZENSHIP UNDER REPUBLIC ACT NO. 9225
2x2 colored picture
2x2 colored picture
White background
White background
(front view)
(front view)
Indicate “N/A” if not applicable. Do not leave any space blank. Print all information LEGIBLY.
I, ___________________________________, of legal age, ___________ a/an ________________, and a resident of
Full name of petitioner
civil status
nationality/citizenship
____________________________, with contact no. ______________ after been duly sworn to in accordance with law,
Complete address in the Philippines
Tel. No. / Mobile No.
hereby declare under oath that:
1. I am a former natural-born Philippine citizen, born on ______________ at ________________ to _______________
date of birth
place of birth
Father’s name
________________ citizen and ______________________________, a _____________________ citizen:
Father’s citizenship
Mother’s name
Mother’s citizenship
2. I became a ___________________ national on ________________, thereby lost my Philippine citizenship. Pursuant
Foreign citizenship
date of acquisition
thereto, I am holder of _______________ passport with Passport No. ___________ , issued on _________ at ___________;
foreign passport
3.
(If registered with the Bureau). I am a holder of Alien Certificate of Registration (ACR) No. _______________ and
Immigrant Certificate of Residence / Certificate of Residence for Temporary Visitors (ICR/CRTV) No. ___________________;
4. (If with Dependent/s) Include in this petition is/are my unmarried child/children below 18 years old;
Name
Relationship
Date of Birth
Age
________________________________
_________________ ___________________
_______
________________________________
_________________ ___________________
_______
5.
I am freely and voluntarily filing this petition to re-acquire my Philippine Citizenship, knowing fully well its
concomitant rights and obligations;
6. This petition with the Bureau is being filed in accordance with Republic Act No. 9225 and its implementing rules
and regulations.
___________________________
Signature of petitioner
VERIFICATION
I, ___________________________, the petitioner, hereby certify that the allegations herein are true and correct to the
best of my knowledge and belief.
_________________________
Signature of petitioner
SUBSCRIBED AND SWORN TO, before me this ______________ in the City of Seoul, petitioner exhibiting to me his/her
passport/ID with no. ___________________ issued on ______________ at ____________.
Doc. No.
Book No.
Page No.
Series of 2014

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