Fa Form No.40 - Report Of Birth - Consulate General Of The Philippines In Sydney, Australia

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NOT FOR SALE

REPUBLIC OF THE PHILIPPINES

FA FORM NO.40

DEPARTMENT OF FOREIGN AFFAIRS

(REVISED MARCH 2013)

REPORT OF BIRTH

DATE OF REPORT

(day-month-year)

CHILD BORN ABROAD OF FILIPINO PARENT/S

THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE.

Registry No.

Foreign Service Post: Philippine Consulate General, Sydney

DETAILS OF CHILD'S BIRTH

5. DATE OF BIRTH

1. CHILD'S LAST NAME

(day-month-year)

2. CHILD'S FIRST NAME

6. TIME OF BIRTH

3. CHILD'S MIDDLE NAME

7. SEX:

FEMALE

MALE

4. PLACE OF BIRTH

8. CIVIL STATUS OF PARENTS

MARRIED

NOT MARRIED

DETAILS OF PARENTS (at the time of child's birth)

INFORMATION ON CHILD'S FATHER

INFORMATION ON CHILD'S MOTHER

9. LAST NAME

10. FIRST NAME

11. MIDDLE NAME

12. NAME BEFORE MARRIAGE

13. CITIZENSHIP

14. DATE OF BIRTH

(day-month-year)

15. PLACE OF BIRTH

16. OCCUPATION

17. RELIGION

18. HOME ADDRESS

19. NATURALIZED (if foreign born)

20. DATE & PLACE OF REGISTRATION

AS PHILIPPINE CITIZEN

(day-month-year/ place of registration)

21. DATE OF MARRIAGE

24. PLACE OF MARRIAGE

(day-month-year)

22. NUMBER OF PREVIOUS CHILDREN

25. NUMBER OF CHILDREN NOW LIVING

23. SIGNATURE OVER PRINTED NAME & ADDRESS OF PARENT, PHYSICIAN OR NURSE

WHEN REPORTED BY MAIL, USE THIS PORTION IN THE PRESENCE OF TWO WITNESSES:

WHEN REPORTED IN PERSON, USE THIS PORTION:

Subscribed

and

sworn

before

this

_______

day

Declared in our presence this ____ __day of _________________

_______________________ at the Embassy/Consulate of the Philippines

at____________________________________________________.

in Sydney, Australia .

First Witness:

__________________________________________________

Address:

__________________________________________________

Second Witness:

__________________________________________________

Address:

__________________________________________________

SEAL

REPUBLIC OF THE PHILIPPINES

EMBASSY/ CONSULATE OF THE REPUBLIC OF THE PHILIPPINES

The foregoing information was furnished by (father, mother, physician, nurse) and supported by (affidavit, physician's certificate, certificate from local authorities).

This report has been executed in quadruplicate, copy issued to parents, copy transmitted to the Department of Foreign Affairs (DFA) in Manila, copy transmitted to the Civil

Registrar General through the DFA and copy placed in the files of this Office.

Date: __________________________

Service No.: _____________________

O.R. No.:________________________

SEAL

REPUBLIC OF THE PHILIPPINES

Fee Paid: _______________________