Philippine Embassy In Vietnam Passport Application Form
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1
2Philippine Embassy
Ha Noi, Socialist Republic of Viet Nam
PASSPORT APPLICATION FORM
FILL-IN BLANKS: TYPE OR PRINT LEGIBLY. (
Please see requirements on the reverse side)
SURNAME
GIVEN NAME
MIDDLE/MAIDEN NAME
Photo Size
DATE OF BIRTH
4.5 X 3.5 cm
PLACE OF BIRTH
SEX
MALE
FEMALE
CIVIL STATUS
Single
Married
Widow/er
Divorced/Separated
Name of father:
Citizenship:
Name of Mother::
Citizenship:
Name of Spouse, if married:
Citizenship:
if widowed or divorced, name of previous spouse:
ADDRESS IN VIETNAM:
Number
Street
Town/City
Province
Telephone No.:
E-mail Address:
LEGAL STATUS IN VIETNAM:
Temporary Resident
Contract Worker
Seaman
Student
Tourist
Others
Occupation::
Name of Employer/Company:
Telephone No.
Address:
CHECK IF YOU ARE
HAVE YOU EVER BEEN ISSUED A PHILIPPINE PASSPORT
Legitimate
Illegitimate
Yes
No
Latest Passport No.
PHILIPPINE CITIZENSHIP ACQUIRED BY:
Date of Issue
Place of Issue
Birth
Election
Naturalizataion
Marriage
ARE YOU A PHILIPPINE GOVERNMENT EMPLOYEE?
HAVE YOU RENOUNCED YOUR PHILIPPINE CITIZENSHIP?
HAVE YOU ACQUIRED OTHER FOREIGN CITIZENSHIP?
Yes
No
If yes, please specify foreign citizenship
IN CASE OF EMERGENCY PLEASE NOTIFY:
In Vietnam:
In the Philippines:
Name:
Name:
Address:
Address:
Telephone /Mobile No.
Telephone /Mobile No.
E-mail address:
E-mail address:
I SOLEMNLY SWEAR that the attached photograph is mine, that the statements made on this application form are true and the attached
supporting documents are authentic.
Photo Size
4.5 X 3.5 cm
Signature of Applicant
Date of Application
LEFT THUMBMARK
RIGHT THUMBMARK
Warning: Perjury is punishable by law.
For Official Use only:
Fee:_________ O.R. No.:_________________
Service No.:_________________
Processor:____________________________
Date: ______________________
LOL/Scripter__________________________
Date:______________________
Signing Officer
New Passport No.:_____________________
Date of Issue:_______________
Passport Released/Mailed by:
Received by:
Date
Date:__________
Date:__________
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