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PNP Dependent's ID Application Form

PNP application form for dependent's ID

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: PHILIPPINE NATIONAL POLICE
ID APPLICATION FORM
(PNP DEPENDENT)
PNP ID Application Form-2012B (NOT FOR SALE)

Fill in all applicable spaces correctly and legibly. Mark all appropriate boxes with X.
Renewal / Update ID

New ID

Control No.

Replacement ID

DEPENDENT DATA:
Last Name:

First Name:

Middle Name:

Qualifier:

Home Address:
Date of Birth (MM-DD-YYYY):

TIN No:

Weight:

Height:

Blood type:

Color of Eyes:

Color of Hair:

Other
Other Identifying Marks: Identifying Marks:

Contact no.:
Contact no.:
Email address:

Person to be notified in case of emergency:
Name:

Relationship:

Address of person to be notified:

Contact no.:

DEPENDENT OF (Name of PNP Personnel):

Date accomplished:

Present Unit Assignment:

Contact Number:

I hereby declare, under the penalty of law, that the entries made herein are true and correct, and that the above-named applicant is my legal beneficiary and executed to the best of my knowledge.
I also authorize the PNP/authorized representative to verify/validate the contents stated herein.
SIGNATURE OF SPONSORING PNP PERSONNEL: ___________________________

2x2 colored picture with
white background and the
name should appear below the
picture (Last Name, First Name,
M.I.)

Signature of Applicant
(in black ball pen)

Right Thumb Mark

Picture should be without
headgear, without moustache, eye
glasses or sun glasses. Must wear
appropriate attire (dependents).

REQUIREMENTS:

INSTRUCTIONS:

(1) Application Form endorsed by COP/PD/CD/Bn Comdr; C, PHRDD/ARMD; Regional Chief,
NOSU/NASU or Pers/Admin Officer of NHQ Offices/Directorates;
(2) Updated Certificate of Legal Beneficiary (CLB) issued by RMD, DPRM;
Requirements for CLB of Active PNP members:
a. Unit Endorsement
b. (Notary Public) Affidavit of Confirmation-COMPUTERIZED
c. ORIGINAL COPY of NSO-issued Marriage Contract with Official Receipt.
d. Original Copy of NSO-issued Advisory on Marriages of both husband and wife with Official Receipt.
e. Original Copy of NSO-issued Birth Certificates of Dependents with Official Receipt.
f. Photocopy of ID with 3 signatures and 2x2 picture with nametag of Dependents and PNP member.
g. Original Copy of NSO-issued DEATH CERTIFICATE With official Receipt if DEPENDENT is already
deceased.
h. ORIGINAL COPY OF NSO-issued Certificate of No Marriage (CENOMAR) with Official Receipt if
SINGLE/ UNMARRIED.
(3) Affidavit of Loss and Police Report, if lost;
(4) At least one (1) valid government-recognized ID; and,
(5) Payment for the Dependent ID card (Current: P60.00).

1. Submit duly accomplished application form & required documents to the
COP/PD/CD/Bn Comdr; C, RPHRDD/ARMD; Regional Chief, NOSU/NASU or
Pers/Admin Officer of NHQ Offices/Directorates for verification/confirmation of
entries and signature.

CERTIFICATION:
I hereby certify to the veracity of the entries made
herein and confirm the identity of the applicant:

2. The application signed by the COP/PD/CD/Bn Comdr; C, RPHRDD/ARMD;
Regional Chief, NOSU/NASU or Pers/Admin Officer of NHQ Offices/Directorates
will be forwarded to the Records Management Division (RMD), DPRM thru their
liaison officer or by mail/commercial courier.
3. All applications sent by mail/commercial courier must have a pre-paid return
envelope.
4. Regular Processing Period: (with CLB: 2-3 days)
5. Application forms with different/inconsistent data with PAIS Record/PPF will be
verified separately; hence processing will be longer.
6. All printed IDs not claimed within 30 days will be sent to C, RPHRDD/ARMD;
Personnel/Admin Officer of unit/office.

VERIFIED BY:

(ACTION OFFICER - ID SECTION)
(Signature over Printed Name)
CHIEF OF UNIT/OFFICE OR PERSONNEL/ADMIN OFFICER

(RANK)

(UNIT/OFFICE)

PROCESSED BY:

REVIEWED BY:

(CHIEF, ID SECTION)

APPROVED BY:
FOR TDPRM:

(ACTION OFFICER - ID SECTION)

CP No. : ________________________________________

ID RECEIVED BY / RELEASED TO:

DATE:
 
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