E-Passport Application Form - Republic Of The Philippines - Department Of Foreign Affairs
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1Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
Philippine Embassy, Seoul, South Korea
E-PASSPORT APPLICATION FORM
/
/
_____________________________________
____________________________________
____________________________________
LAST NAME
FIRST NAME
MIDDLE NAME
/ APELYIDO
/ PANGALAN (JR./ II)
/ GITNANG APELYIDO
________________ / ____________ / ____________
________________________________________________________
PLACE OF BIRTH
Month
Day
Year
/ LUGAR NG KAPANGANAKAN
DATE OF BIRTH
/ PETSA NG KAPANGANAKAN
GENDER
MOBILE PHONE No
/ KASARIAN
MALE
FEMALE
.: __________________________________
Civil Status:
Single
Married
Widow/er
Legally Separated
Annulled
Divorced
Name of Wife / Husband: _________________________________ Mobile No.: _____________________ Citizenship: _____________
=================================================================================================
Applicant’s Complete Address in South Korea (in English): ____________________________________________________________
____________________________________________________________________________________ E-mail: ________________________
Applicant’s Complete Address in the Philippines: _____________________________________________________________________
____________________________________________________________________________________ Tel. No. ________________________
Name of Applicant’s Father : ________________________________________________________ Citizenship: ____________________
Single Name of Applicant’s Mother: _________________________________________________ Citizenship: ____________________
================================================================================================
In Case of Emergency:
Name of family member in the Philippines to be contacted: __________________________________________________________
Relationship: ________________________Contact Number: ______________________________E-mail: _________________________
Complete Address in the Philippines: ________________________________________________________________________________
Filipino Citizenship Acquired by:
Birth
Naturalization
Marriage
R.A. 9225
Election
Are you a holder of a Foreign Passport?
Details of Current Philippine Passport:
Passport Number : _____________________________________
[ ] Yes
[ ] No
Place of Issue
: _____________________________________
Date of Issue
: ______________________________________
If Yes, from what country? ______________________________
If Available:
OWWA ID: ________________ PAG-IBIG ID: ________________ PHILHEALTH ID: ________________Driver’s License No.: _____________________
SSS No. ______________Overseas Employment Certificate (OEC) No. ________________ Tax Identification Number (TIN): _______________
If Applicant is Minor (below 18 years old), Please fill-up:
Name of Minor’s Traveling Companion: ___________________________________________________________________________
Companion’s Relationship to the Minor: _____________________Contact No. in South Korea ___________________________
Companion’s Address in South Korea : ____________________________________________________________________________
I SOLEMNLY SWEAR that 1) I am a Filipino citizen; 2) the information in this application are true and correct; 3) the supporting
documents are authentic; 4) I am aware that under the law, I am allowed to hold only one Philippine Passport at any
given time; and, 5) I am aware that making false statements in this passport application, furnishing falsified or forged
documents in support thereof are punishable by law.
Please Sign:
_______________________________________________________________
SIGNATURE OF APPLICANT
or
LEGAL GUARDIAN (For Minor Applicant)
FOR THE USE OF THE PHILIPPINE EMBASSY ONLY. PLEASE DO NOT WRITE BELOW THIS LINE
Remarks:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Processor:
Encoder:
Signing Officer:
Received Cancelled Passport:
Received New Passport:
For additional information, please visit the Philippine Embassy website:
rsh.rca.ekrm.ucmjr.fcg.feb2016:
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