Passport Application Form - Republic Of The Philippines Department Of Foreign Affairs
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1Republic of the Philippines
JVBL-APCE-LVJZ-PPT-DO Rev. July 2012
DEPARTMENT OF FOREIGN AFFAIRS
PASSPORT APPLICATION FORM
THIS APPLICATION FORM IS NOT FOR SALE. PLEASE DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE.
PROVIDING FALSE STATEMENTS IN PASSPORT APPLICATIONS IS PUNISHABLE BY LAW (R.A. 8239).
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 / PETSA NG KAPANGANAKAN
(Ex.: March 8, 2010)
□ Single
□ Married
□ Widow/er
□ Legally Separated
□ Annulled
Civil Status:
Complete Address: ______________________________________________
Tel. No.: __________________
(Abroad)
______________________________________________
Present Occupation: _____________________________________________
Mobile No.: ________________
Work Address: _________________________________________________
Tel. No.: __________________
E-mail Address: ______________________________________________________________________________
Name of Wife / Husband: _________________________________________
Citizenship: _______________
Name of Father: ________________________________________________
Citizenship: _______________
Maiden / Single name of Mother: ____________________________________
Citizenship: _______________
Citizenship Acquired By:
□ Birth
□ Election
□ Marriage
□ Naturalization
□ R.A. 9225
□ Others_____________
Are you a holder of a foreign passport? □ Yes □ No
Have you ever been issued a Philippine Passport? □ Yes □ No
If Yes, from what country?______________________
If Yes, latest Passport Number? _____________________
Date of issue: ___________ Place of issue: ________________
(For applicants below 18 years old ONLY)
Name of minor’s travelling companion: ______________________________________________________
Companion’s relationship: ______________________ Contact Number: __________________________
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application are
true and correct. 3) The supporting documents attached are authentic. 4) I am aware that under the law, I am
allowed to hold only one Philippine passport at any given time. 5) I am aware that making false statements in
passport application, furnishing falsified or forged documents in support thereof are punishable by law.
Signature of Applicant or Legal Guardian (for minor applicants)
FOR USE OF THE PHILIPPINE EMBASSY / CONSULATE ONLY. PLEASE DO NOT WRITE BELOW THIS LINE.
REMARKS:
Processor:
Encoder:
Signing Officer:
Transmission Officer:
RECEIVED CANCELLED PASSPORT:
RECEIVED NEW PASSPORT:
FOR ADMINISTRATIVE USE ONLY:
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