Form 2014-01-005 - Petition Form For Retention/re-Acquisition Of Philippine Citizenship Under R.a. 9225
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1BI FORM 2014-01-005 Rev 0
This document may be reproduced and is NOT FOR SALE
PETITION FORM FOR RETENTION/RE-ACQUISITION OF
PHILIPPINE CITIZENSHIP UNDER R.A. 9225
PETITION
I, ____________________________________________________________________________,
[Name in Philippine Document]
also known as _______________________________________________________, _____ years of age,
[Name in foreign passport]
male/female, am single/widowed/divorced/annulled/separated/married to _________________________
(underline applicable)
____________________________. I, a citizen of _________________and resident of _______________
____________________________________________ with contact number ______________________,
after being sworn to in accordance with law, hereby declare under oath that:
1. I am a former natural-born Philippine citizen, born on ___________________________________
[DD-MMM-YYYY e.g. 01 JAN 1990]
at ___________________________to _______________________________________________,
[Father’s name]
[as appearing in Philippine document]
_______________________________citizen by birth/election/marriage/naturalization, who was
[at the time of the petitioner’s birth(underline applicable)]
[Father’s citizenship at the time of petitioner’s] birth
married/not married to ___________________________________________________________,
[Mother’s name]
_____________________________citizen by birth/election/marriage/naturalization;
[at the time of petitioner’s birth (underline applicable)]
[Mother’s citizenship at the time of petitioner’s birth]
2. I lost my Philippine citizenship when I became a citizen of ________________________________
on _____________________. Presently, I am a holder of a valid ___________________ passport
with number _________________ issued on ___________________ at ____________________;
[DD-MMM-YYYY e.g. 01 JAN 1990]
3. I took my Oath of Allegiance to the Republic of the Philippines on __________________________
[DD-MMM-YYYY e.g. 01 JAN 1990]
at _______________________________;
(If the petitioner is a registered alien with the Bureau of Immigration):
4. I
surrender
for
cancellation
my
original
Alien
Certificate
of
Registration
(ACR)
no. _______________________and/or Immigrant Certificate of Residence/Certificate of Residence
for Temporary Visitors (ICR/CRTV) no. _________________________;
(If with Dependent/s):
5. Included in this petition is/are my unmarried child/ren below eighteen (18) years of age, namely:
Name
Gender
Date of Birth
Age
[DD-MMM-YYYY e.g. 01 JAN 1990]
_______________________________________
_______
________________________
_____
_______________________________________
_______
________________________
_____
_______________________________________
_______
________________________
_____
(Please use BI Form 2014-01-006 Rev 0 for each dependent to be attached to this petition.)
WHEREFORE, it is prayed that this petition for
Attach your 2x2 colored
Retention
and/or
Re-acquisition
of
Philippine
photographwith white
background using
Citizenship
under
Republic
Act
No.
9225
be
permanent glue in the
GRANTED.
photograph box.
The photograph must be taken
within the last three (3) months
from the date of application.
____________________________________________________
A scanned photograph is not
Signature over Printed Name
allowed. A photograph of the
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses,
__________________________________________
etc.) or headwear is not acceptable.
Date [DD-MMM-YYYY e.g. 01 JAN 1990]
VERIFICATION
I certify under oath that the above statements are true and correct to my own personal knowledge, and based on authentic
documents in my possession.
________________________________________
Applicant’s Signature over Printed Name
SUBSCRIBED AND SWORN TO before me this ______________ in _______________________, Petitioner personally
appeared and exhibited to me his/her passport with number _____________________ issued on ____________________________
at __________________.
Doc No.: _________
Page No.: ________
Book No.: ________
Series of ________
Page 1 of 1
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