Republic of the Philippines
Consulate General of the Philippines
Milan, Italy
E-Passport Application Form
PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK / IF POSSIBLE PLEASE AVOID ERASURES
_________________________________________
_________________________________________
Last Name/Apelyido
First Name/Pangalan (Jr. / II / III)
_________________________________________
Middle Name/Gitnang Pangalan
_________________________________________
Place of Birth/Pook ng Kapanganakan
__________/_________________/____________
Day
Month
Year
Date of Birth/ Petsa ng kapanganakan (Ex. 01 January 2000)
Gender / Kasarian :
MALE
FEMALE
Civil Status:
Single
Married
Widow/er
Legally Separated / Annulled
Complete Address in Italy:_________________________________________________________________ Mobile No.:_______________________
Complete Address in the Philippines:_________________________________________________________Contact No.:_______________________
Name of Father: _____________________________________________________________________________ Citizenship: ___________________
First Name
Middle Name
Last Name
Name of Mother: ____________________________________________________________________________ Citizenship: ___________________
First Name
Middle Name
Last Name (before marriage)
Name of Spouse: ____________________________________________________________________________ Citizenship: ___________________
First Name
Middle Name
Last Name
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, Latest passport Number:________________________
If Yes, from what country?________________________
Date of Issue:__________________Place of Issue:___________________
Passport No.: ______________________
Reason for application of Philippine Passport:
Date of Issue:__________________Place of Issue:______________
Renewal
New
Reacquisition of PHL Citizenship
Lost
Date of Oath Taking:____________
Occupation___________________________________
Name of Employer____________________________________________
Address of Employer____________________________________________________________________________________________________
In case of accident or death, please notify:
In the Philippines
In Italy
Name:_________________________________________________
Name:_________________________________________________
Address:_______________________________________________
Address:_______________________________________________
_______________________________________________________
_______________________________________________________
Contact No.:_____________________________________________
Contact No.:_____________________________________________
For Minor applicants
Name of Parent/Legal Guardian
Relationship to applicant
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.
________________________________
Signature of Applicant
REMARKS:
FOR STRICT COMPLIANCE: Please print name and affix initials.
OR #: ________________
Processor:
Encoder:
Signing Officer:
Cashier: