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CSS-A-NTSP-2016 Application Form for Request for Certificate of NTSP
BI application form for request certificate of not the same person
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CCS-A-NTSP-2016 This document may be reproduced and is NOT FOR SALE
APPLICATION FOR FOR REQUEST FOR
FORM
CERTIFICATE OF NOT THE SAME PERSON (NTSP)
Paste here recent 2x2 colored
picture with white background.
The photo must be taken within the
last three (3) months from the date
of application.
A scanned copy photo and photo
wearing eyewear like eyeglasses or
colored contact lenses will not be
accepted.
SUBJECT PERSONAL INFORMATION
SUBJECT’S
Last Name
First/
First/Given Name
Middle Name
Other Name
Name(s)/Alias(es)
1
2
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990
1990]
Gender
M
F
Place of Birth
Citizenship/Nationality
Residential/Registered Address in the Philippines
House/Unit No., Street, Subdivision/Village
/Village
Barangay, Municipality/City
Province, Zip Code
Passport Number
Contact Number(s) in the Philippines
Landline
Mobile
Purpose:_________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
_______________________________
________________________________
Date [DD-MMM-YYYY]
____________________________________________
Signature over PRINTED NAME of Applicant
Certification and Clearance Section (CCS) Window
RECEI
RECEIVED: ________________________________________
______________
Date & Time
RELEASED: _______
________________________________________
_____________
Date & Time
[To be filled out by Authorized BI Personnel Only]
CERTIFICATE OF NOT THE SAME PERSON CLAIM STUB
Name of SUBJECT[Last Name, First/Given Name, Middle Name]
[Last
_______________________
Date of Birth [DD-MMM-YYYY]
Citizenship/Nationality
Always present this claim stub upon claiming your certificate
certificate.
Unclaimed certificate shall be automatically cancelled after 30 days from the date of issuance
issuance.
If claimed by an authorized representative, present a Special Power of Attorney (SPA) and original
valid government-issued ID.
Date & Time FILED
_______________________
Date & Time RELEASED
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