Application Form Citizenship Retention And Re-Acquisition Form - Republic Of The Philippines - Embassy Of The Philippines, Seoul, South Korea Page 2
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1
2
3Republic of the Philippines
Department of Justice
BUREAU OF IMMIGRATION
Intramuros, Manila
APPLICATION FORM
CITIZENSHIP RETENTION AND RE-ACQUISITION
(under R.A. 9225)
Left Side View
Front View
Right Side View
Indicate “N/A” if not applicable. Do not leave any space blank. Print all information.
Print legibly. Mark appropriate boxes
with check
I. Personal Data
FULL NAME: _____________________________________________________________________________________
(Last Name / Surname)
Middle Name
First Name
Birthdate: _____________________
Age: _________
Birth Place: _____________________________
Civil Status: ____________________
Sex: _________
Nationality: ____________________
Height: __________
Weight (Kg): _________
Mode by which Philippine citizenship was acquired:
By Birth
By Marriage
By Election
By Adoption
By Naturalization
Others, specify: _______________________________
Mode by which Foreign citizenship was acquired:
Date Acquired: ________________________________
By Birth in a Foreign Country
By Marriage
Born of an Alien Parent
By Derivative Naturalization
By Naturalization
Others, specify: _______________________________
Philippine Address: _________________________________________________________ Tel. No. ________________
Address outside the Philippines: _______________________________________________ Mobile No. _____________
Email Address: ____________________________________________________________________________________
Name of Spouse: _________________________________________________ Nationality: ______________________
Father’s Name: ___________________________________________________ Birthdate: _______________________
Father’s Nationality at the time of the Petitioner’s Birth: __________________________________________________
Mother’s Maiden Name: _____________________________________________ Birthdate: ______________________
Mother’s Nationality at the time of the Petitioner’s Birth: _________________________________________________
II. Immigration Status
Date of Latest Arrival: __________________________________
Validity: _____________________________________________
Status of Admission Upon Entry: _______________________________________________________________________________
Passport No.: ________________________________________
Validity: _____________________________________________
A.C.R. No.: __________________________________________
Date of Issue: ________________________________________
I.C.R. No.: ___________________________________________
Date of Issue: ________________________________________
Re-entry Permit No.: __________________________________
Date of Issue: ________________________________________
III. Name of Person(s) Included as Dependent(s) in this Petition.
Name
Relationship
Date of Birth
Age
___________________________________________________
___________________
________________
_____
___________________________________________________
___________________
________________
_____
______________________________________________
_________________
______________
_____
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