HTML Preview Printable Passport Application page number 1.
Republic of the
Philippines
DEPARTMENT OF FOREIGN
AFFAIRS
PASSPORT APPLICATION FORM
JVBL-APCE-LVJZ-PPT-DO Rev. July 2012
THIS APPLICATION FORM IS NOT FOR SALE. PLEASE DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE. PROVIDING FALSE
STATEMENTS IN PASSPORT APPLICATIONS IS PUNISHABLE BY LAW (R.A. 8239).
LAST NAME
/ APELYIDO
FIRST NAME
/ PANGALAN (Jr./II/III)
MIDDLE NAME
/ GITNANG PANGALAN
PLACE OF BIRTH
/ POOK NG KAPANGANAKAN
/
/
Month
Day Year
DATE OF BIRTH
/ PETSA NG KAPANGANAKAN
(Ex.: March 8, 2010)
GENDER
/ KASARIAN
□
MALE
□
FEMALE
Civil Status
:
□
Single
□
Married
□
Widow/er
□
Legally Separated
□
Annulled
Complete Address:
Present Occupation:
Work
Address:
Tel. No.:_
Mobile
No.:_
Tel.
No.:_
E-mail
Address:
Name of Wife / Husband:
Name
of Father:
Maiden
/
Single
name
of
Mother:
Citizenship:
Citizenship:
Citizenship:
C
itizenship
A
cqui
r
ed
B
y:
□
Birth
□
Election
□
Marriage
□
Naturalization
□
R.A.
9225
□
Others
Are you a holder of a foreign passport?
□
Yes
□
No
If
Yes,
from
what
country?
Have you ever been issued a Philippine Passport?
□
Yes
□
No
If Yes, latest Passport Number?
Date
of
issue:
Place
of
issue:
(For applicants below 18 years old
ONLY)
Name
of
minor’s
travelling
companion:
Companion’s relationship: Contact Number:
I SOLEMNLY SWEAR
that 1) I am a Filipino citizen. 2) The information I provided in this application are true and
correct. 3) The supporting documents attached are authentic. 4) I am aware that under the law, I am allowed to hold only one
Philippine passport at any given time. 5) 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 or Legal Guardian (for minor applicants)
FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRS ONLY. PLEASE DO NOT WRITE BELOW THIS LINE.
REMARKS:
Processor: Encoder: Signing Officer: Transmission Officer:
RECEIVED CANCELLED PASSPORT:
RECEIVED NEW PASSPORT:
FOR ADMINISTRATIVE USE ONLY:
For more details please visit
http://www.philippineembassy-
usa.org/philippines-dc/consular-services-
dc/