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Renewal Passport Application Adult

DFA form for RENEWAL Passport Applications Adult

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Form No. 1 – ENGLISH

NEW REGULAR PASSPORT APPLICATION (Adult)
DEPARTMENT OF FOREIGN AFFAIRS
Office of Consular Affairs Last Revision: 07 October 2017

THIS FORM IS NOT FOR SALE

INSTRUCTIONS: Please PRINT entries legibly using black or blue
ink only. Supply the necessary information and indicate “N/A” for
entries with no answers. Tick (√) boxes as appropriate.

Site: XXXXXXX
Date/Time: Day, DDMon YYYY/0000HR
Booking Reference no.:0123456789101112

CAPTURE SITE PRE-PROCESSING (Do not write on this part)
APPOINTMENT VERIFICATION:

REMARKS:

PASSPORT APPLICANT’S INFORMATION
1.LAST NAME

2. FIRST NAME

3. MIDDLE NAME or MAIDEN LAST NAME

4. SEX

5. DATE OF BIRTH (ex. 01 Jan 2017)
FEMALE

7. CIVIL STATUS

6. PLACE OF BIRTH
(For born in the PHL: Municipality/City & Province
For born outside the PHL: Country)

MALE
D D

M M M

Y Y Y Y

8a.HOW DID YOU ACQUIRE PHL CITIZENSHIP? 8b. DID YOU EVER LOSE YOUR PH

SINGLE

BY BIRTH

MARRIED

BY NATURALIZATION

WIDOW/ER

BY RE-ACQUISITION (RA 9225)

NULLIFIED /
ANNULLED
DIVORCED

BY ELECTION

CITIZENSHIP?
YES
8c.ARE YOU CURRENTLY A CITIZEN OF
ANOTHER COUNTRY?
YES
8d.IF YES, FROM WHAT COUNTRY?

NO
NO

8e. HAVE YOU SERVED IN ANY FOREIGN
MILITARY?
YES
NO
IF Yes, what country?

BY LEGISLATION

APPLICANT’S CONTACT INFORMATION
9a. HOME ADDRESS:

9b. PRESENT ADDRESS:

10. WHERE DO YOU WISH YOUR PASSPORT TO BE DELIVERED?
HOME ADDRESS
PRESENT ADDRESS
11. TELEPHONE/MOBILE NUMBER:
12. e-MAIL ADDRESS:
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13. APPLICANT’S SPOUSE’S NAME:
14a. PERSON TO CONTACT IN CASE OF EMERGENCY:

14b. TEL/MOBILE NO.:

PARENTAL INFORMATION
15. FATHER’S DETAILS
Last Name:
First Name:

16. MOTHER’S DETAILS
Last Name:
First Name:

Middle Name:

Middle Name:

Citizenship (at time of applicant’s birth)

Citizenship (at time of applicant’s birth)
DECLARATION OF APPLICANT

I HEREBY DECLARE AND AFFIRM that 1) I am a Filipino citizen. 2) The information provided in this application is true
and correct. 3) The supporting documents attached are authentic. 4) I consent to the verification by the Philippine
Government of the information I provided to establish my personal particulars, and further consent to its use for
any lawful purpose. 5) I am aware that the information provided in this application will be treated in accordance
with relevant privacy regulations. 6) I am aware that under the law, I am allowed to hold only one valid regular
Philippine passport at a given time. 7) I am aware that making false statements in this passport application and
furnishing falsified or forged documents are punishable by fine or imprisonment, and grounds for suspension or
denial of application. 8) I understand and accept that the release of the passport could be subject to delay due to
unforeseen events beyond the control of the Department of Foreign Affairs.

_____________________________________
17. SIGNATURE OVER PRINTED NAME

_______________________________
18. DATE (ex. 01 Jan 2017)

DO NOT WRITE BELOW THIS LINE. FOR THE DEPARTMENT’S USE ONLY.
PROOF OF PHL CITIZENSHIP
BIRTH CERTIFICATE from PHL
Statistics Authority
CERTIFICATE OF
NATURALIZATION
IDENTIFICATION CERTIFICATE OF
CITIZENSHIP

ELECTION OF PHL CITIZENSHIP
Others:

IDENTITY DOCUMENT SUBMITTED
COMELEC Voter’s ID
LTO Driver’s License
Professional Regulatory
Commission ID
Unified Multipurpose ID
(UMID)
PWD ID
GSIS / SSS ID
Senior Citizen’s ID
Others:

REMARKS:

SUPPORTING DOCUMENTS
Marriage Certificate from PHL
Statistics Authority
Voter’s Registration Record
Court Order
NBI Clearance
Others:

PASSPORT WATCHLIST VERIFICATION:

PROCESSOR’S SIGNATURE:

ENCODER’S SIGNATURE:

OFFICIAL RECEIPT/PAYMENT SLIP NO.:

DATE OF TRANSACTION:
END

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