PASSPORT APPLICATION FORM
THIS FORM IS NOT FOR SALE
DEPARTMENT OF FOREIGN AFFAIRS
Office of Consular Affairs
Revised as of 15 JULY 2019
INSTRUCTIONS:
Read CAREFULLY.
Please PRINT entries legibly using black or blue ink only.
Supply the necessary information.
Indicate “N/A” for entries with no answers.
Tick boxes as appropriate.
APPLICANT’S PASSPORT DETAILS
STATUS OF CURRENT PASSPORT (CHECK ONE; LEAVE BLANK IF NEW PASSPORT APPLICANT)
☐ Passport Intact ☐ Lost Valid Passport ☐ Lost Expired Passport ☐ Damaged Passport
NAME TO BE PRINTED IN
YOUR NEW PH PASSPORT
FIRST NAME (INCLUDE SUFFIX, I.E. JR.,III etc.)
SEX (CHECK ONE)
☐ MALE ☐FEMALE
DATE OF BIRTH (MONTH-DAY-YEAR) (EX. JULY 23 1962)
PLACE OF BIRTH (IF BORN WITHIN THE PHILIPPINES, WRITE THE MUNICIPALITY/CITY AND PROVINCE. IF BORN
OUTSIDE THE PHILIPPINES, WRITE THE COUNTRY)
☐ SINGLE ☐ MARRIED ☐WIDOW/ER ☐ ANNULLED/NULLIFIED BY PHILIPPINE COURT ☐ DIVORCE/ANNULMENT RECOGNIZED BY PHILIPPINE COURT
NAME OF APPLICANT’S SPOUSE
ARE THERE CHANGES IN
YOUR NAME? (CHECK ONE)
REASONS FOR NAME CHANGE
(CHECK ONE; PRESENT CERTIFIED COPY)
☐ PH GOVT REPORTED
MARRIAGE
☐ PH COURT ORDER
FEMALE APPLICANT OPTED
TO USE MAIDEN SURNAME
☐YES ☐ NO
(IF YES, APPLICANT TO PUT INITIALS
HERE :)
APPLICANT’S CONTACT INFORMATION (FOR MINORS, INDICATE PARENT/GUARDIAN’S CONTACT INFORMATION)
EMERGENCY CONTACT
INFORMATION
APPLICANT’S PARENTAL HISTORY
FATHER
(FILL UP EVEN IF DECEASED;
N/A IF UNKNOWN)
CITIZENSHIP AT THE TIME OF
APPLICANT’S BIRTH
MOTHER
(FILL UP EVEN IF DECEASED;
N/A IF UNKNOWN)
CITIZENSHIP AT THE TIME OF
APPLICANT’S BIRTH
ADULT APPLICANT
(Check One)
MINOR APPLICANT**
**Below 18 years old (Check One)
☐DUAL CITIZEN UNDER R.A. 9225
☐ DUAL CITIZEN UNDER R.A.9225
MODE OF ACQUIRING PHILIPPINE CITIZENSHIP (CHECK ONE)
☐ BY BIRTH TO FILIPINO PARENT/S ☐ BY NATURALIZATION AS A FILIPINO ☐ BY ELECTION AS A FILIPINO ☐ BY RECOGNITION AS A FILIPINO ☐ BY DUAL CITIZENSHIP UNDER R.A. 9225
☐ LEGITIMATE ☐ ILLEGITIMATE ☐ LEGITIMATED BY PARENTS SUBSEQUENT MARRIAGE
ARE YOU CURRENTLY A CITIZEN OF ANOTHER COUNTRY?
DID YOU EVER LOSE YOUR PHILIPPINE CITIZENSHIP?
HAVE YOU SERVED IN ANY FOREIGN MILITARY?
☐ YES (IF YES, FROM WHAT COUNTRY?)
☐ NO
☐ YES (IF YES, FROM WHAT COUNTRY?)
☐ NO
☐ YES (IF YES, FROM WHAT COUNTRY?)
☐ NO
DISTINGUISHING MARKS ON THE FACE
FOR MINOR APPLICANTS ONLY:
Is the Minor subject of an adoption proceeding or in the partial/full care and custody of an orphanage?
☐ YES. (IF YES, PLEASE PROVIDE PERTINENT DOCUMENTS) ☐ NO
Is there any court order or legal arrangements pertaining to the Minor?
☐ YES. (IF YES, PLEASE PROVIDE PERTINENT DOCUMENTS) ☐ NO
OPTIONS FOR PASSPORT RELEASING (CHECK ONE)
☐ I’ll have it mailed (PLEASE BRING YOUR OWN USPS SELF-ADDRESSED STAMPED ENVELOPE)
☐ Pick up at the Consulate General (PLEASE CHECK YOUR RECEIPT FOR YOUR PASSPORT’S RELEASE DATE)
DECLARATION OF APPLICANT OR PARENT/GUARDIAN OF MINOR APPLICANT
I HEREBY DECLARE AND AFFIRM THAT (1) I/the minor applicant am/is a Filipino citizen; (2) I am the parent or legal guardian
of the minor applicant; (3) The information provided in this application is true and correct; (4) The attached supporting documents
are authentic; (5) I consent to the verification by the Philippine Government of the information I provided to establish my/the
minor applicant’s personal particulars and further consent to the use of said information for any lawful purpose; (6) I am aware
that the information provided in this application will be treated in accordance with relevant privacy regulations; (7) I am aware
that under the law, I/the applicant am/is only allowed to hold one valid regular Philippine passport at a given time; (8) 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; (9) 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.
___________________________________________
SIGNATURE OVER PRINTED NAME OF
APPLICANT OR PARENT/LEGAL GUARDIAN
DATE SIGNED :
DO NOT WRITE BELOW THIS LINE. FOR THE CONSULATE GENERAL’S USE ONLY.
PASSPORT WATCHLIST
VERIFICATION:
RETURNED CANCELLED PASSPORT
_____________________________________________________
Applicant /Representative or Parent/Legal Guardian’s Signature
over Printed Name
DATE:
RELEASED NEW PASSPORT
________________________________________________________
Applicant /Representative or Parent/Legal Guardian’s Signature
over Printed Name
DATE:
All passport applications processed after 19 March 2020 will be released by mail only.
Kindly bring along with your other documents, a USPS envelope that is self-addressed with sufficient prepaid postage for USPS tracking.
06 JUNE 2020
