Passport Application Form
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1
2Pasuguan ng Republika ng Pilipinas
THIS FORM IS NOT FOR SALE
Embassy of the Republic of the Philippines
Vienna, Austria
Laurenzerberg 2, A-1010
Tel No. (00431) 533-24-01 / Fax No. (00431) 533-24-01-24
DATE OF APPLICATION:
___________________
Website:
Email Address:
office@philippine-embassy.at
MONDAY – FRIDAY 08:00 – 12:00 ; 13:00 – 15:00
ePassport Application Form
□
□
NEW
RENEWAL
□
REPLACEMENT OF LOST PASSPORT
PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK
_________________________________
_________________________________
Passport Size
First Name/Pangalan (Jr. / II / III)
Last Name/Apelyido
Last Name/Apelyido
Picture with
white
_________________________________
Background
Gender / Kasarian :
MALE
FEMALE
Middle Name/Gitnang Pangalan
Not older than
6 months
___________________/_______/_____
__________________,______________
City or Municipality
, Province
3.5cm x 4.5cm
Month
Day
Year
MALE
FEMALE
Date of Birth/ Petsa ng kapanganakan (Ex.: January / 01 / 1980)
Place of Birth/Pook ng Kapanganakan
Address in Austria/Croatia/Slovakia/Slovenia/Germany: _________________________________________________________________________
Address in Philippines: _____________________________________________________________________________________________________
Email Address:
Mobile Number: ____________________
_________________________________ Present Occupation: _____________________
Name of Present Employer: __________________________________Work Address: ______________________________ Tel. No. _____________
Civil Status:
Single
Married
Widow/er
Legally Separated / Annulled
Name of Father: First: _______________________Middle:________________________ Last:___________________ Citizenship: ______________
Name of Mother: First: ______________________Middle:________________________ Last:___________________ Citizenship: ______________
Name of Spouse: First: _______________________Middle:_______________________ Last:____________________ Citizenship: ______________
IN CASE OF EMERGENCY, PERSON TO BE NOTIFIED:
In the Philippines:
o
Name: __________________________________ Address: _____________________________________________________ Relation: __________
E-Mail Address: ______________________________________________ Tel. No: (0063)____________ Mobile Number: _____________________
In Austria/Croatia/Slovakia/Slovenia/Germany
o
Name: __________________________________ Address: _____________________________________________________ Relation: __________
E-Mail Address: ______________________________________________ Tel. No: _________________ Mobile Number: ______________________
Citizenship Acquired by:
Birth
Election
Marriage
Purpose of Travel:
Tour
Seaman
Business
Naturalization
R.A. 9225
Others______________
Migration
Study
Work
Others______________
•
•
Are you a holder of a Foreign passport?
Yes
No
Have you ever been issued a Philippine Passport?
If Yes, from what country?________________________
Yes
No
If Yes, Latest passport Number:________________________
•
Would you like to receive Consular information or
Updates/News from the Philippine Embassy via e-mail?
Date of Issue:__________________Place of Issue:___________________
Yes
No
I SOLEMNLY SWEAR that 1) I am a Filipino Citizen. 2) The information I provided in this application is true and correct. 3) The supporting documents attached are
authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am allowed to hold only ONE Philippine Passport at any
given time. 6) I am aware that making false statements in passport application, furnishing falsified or forged documents in support thereof are punishable by law.
___________________________
___________________________
Date of Application
Signature of Applicant
PLEASE DO NOT WRITE BELOW THE LINE
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FOR EMBASSY USE ONLY:
With Postage:
Service Number: _____________
Please print name and affix initials.
Austria: EUR6.00
Croatia/Slovenia/Slovakia: EUR15.00
O.R. Number: ________________
Processor: _____________________________
Germany: EUR25.00 -DHL
Fee: EUR54.00
With:
Report of Birth SN: VN-__________ /2013
Date: _______________________
Signing Officer: _________________________
Report of Marriage SN: VN-_______ /2013
with Certification No. _______/2013 EUR 22.50
RECEIVED CANCELLED PASSPORT:
RECEIVED NEW PASSPORT:
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