Fillable Form No. 3 ENGLISH: REGULAR PASSPORT APPLICATION FORM (gov)

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Form No. 3 ENGLISH: REGULAR PASSPORT APPLICATION FORM (gov)

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Form No. 3 – ENGLISH
REGULAR PASSPORT APPLICATION FORM (Minor)
THIS FORM IS NOT FOR SALE
Supply the necessary information and indicate “N/A” for entries with no answers. Tick () boxes as appropriate.
PASSPORT APPLICANT’S INFORMATION
1. LAST NAME
2. FIRST NAME
3. MIDDLE NAME or MAIDEN LAST NAME
4. SEX
MALE
FEMALE
5. DATE OF BIRTH (ex. 01 Jan 2017)
D
D
M
M
M
Y
Y
6. PLACE OF BIRTH
(For born in PHL: Municipality/City & Province
For born outside PHL: Country)
________________________________
7a. HOW DID THE APPLICANT ACQUIRE PHL CITIZENSHIP?
BY BIRTH BY NATURALIZATION BY RECOGNITION BY DERIVATIVE CITIZENSHIP (RA No. 9225)
7b. HAS THE APPLICANT EVER BEEN ISSUED A REGULAR PHILIPPINE PASSPORT? YES NO
IF YES, PLEASE PROVIDE PASSPORT NO.: ______________________________
DATE ISSUED: _______________________________ ISSUING AUTHORITY: ________________________
9. DISTINGUISHING MARKS ON FACE:
10. IS THE APPLICANT CURRENTLY SUBJECT OF AN ADOPTION PROCESS OR PARTIALLY/FULLY IN THE
CARE OF AN ORPHANAGE? YES NO IF YES, PLEASE PROVIDE PERTINENT DOCUMENTS.
11. IS THERE ANY COURT ORDER OR LEGAL ARRANGEMENTS PERTAINING TO THE CHILD?
YES, THERE IS. NONE THAT I KNOW OF IF YES, PLEASE PROVIDE PERTINENT DOCUMENTS.
APPLICANT’S CONTACT INFORMATION
12. MOBILE PHONE OF PARENT/GUARDIAN:
13. WORK PHONE OF PARENT/GUARDIAN:
14. PERSONAL E-MAIL OF PARENT/GUARDIAN:
15a. PRESENT ADDRESS:
15b. PHILIPPINE ADDRESS:
16. HOW DO YOU WISH TO RECEIVE YOUR PASSPORT? PICK-UP BY MAIL (Pls. Provide Xpress Post Env.)
OFFICIAL RECEIPT/PAYMENT SLIP NO.:
DATE OF TRANSACTION:
DEPARTMENT OF FOREIGN AFFAIRS
Office of Consular Affairs Last Revision: 14 February 2018
Minors are those below eighteen (18) years of age or those over but unable to
fully take care of themselves or protect themselves from abuse, neglect,
cruelty, exploitation or discrimination because of physical or mental disability
or condition (RA No. 7610)
INSTRUCTIONS: Please PRINT entries legibly using black or blue ink only.
Site: OTTAWA PE
Date/Time: Day, DD Mon YYYY/0000HR
____________________________________
Booking Reference No._________________
Page 1 of 2
Form No. 3 – ENGLISH
PARENTAL INFORMATION
18. MOTHER’S DETAILS (MAIDEN /SINGLE NAME)
Last Name:
First Name:
Middle Name:
Citizenship (at time of applicant’s birth)
STATUS OF CURRENT PASSPORT (for renewal of Passport)
Lost Valid Passport
Affidavit of Loss Police Report in English
Lost Expired Passport
Affidavit of Explanation
WAIVER OF LIABILITY
I waive any & all claims that may now and in the future have against, & the release & hold free from any responsibility or
Mail Tracking No: ______________________________________________
DECLARATION OF PARENT OR LEGAL GUARDIAN OF THE APPLICANT
I HEREBY DECLARE AND AFFIRM that 1) The applicant is a Filipino Citizen. 2) I am the parent or legal guardian of the
minor. 3) The information provided in this application are 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 the
applicant’s personal particulars, and further consent to issue 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, the applicant is only allowed to hold 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 the
release of the passport could be subject to delay due to unforeseen events beyond the control of the Department of
Foreign Affairs.
________________________________________ ________________________________
20. SIGNATURE OVER PRINTED NAME 21. DATE (ex. 01 Jan 2017)
OF PARENT OR LEGAL GUARDIAN
PROOF OF CITIZENSHIP SUBMITTED
BIRTH CERTIFICATE from Philippine
Statistics Authority
REPORT OF BIRTH from PHL
Statistics Authority/PHL Embassy or
Consulate
CERTIFICATE OF NATURALIZATION
IDENTIFICATION CERTIFICATE of
CITIZENSHIP
Others: _______________________
IDENTITY DOCUMENT SUBMITTED:
SCHOOL IDENTITY CARD
DSWD CLEARANCE
Others: ____________________
OTHER SUPPORTING DOCUMENTS:
PARENT/GUARDIAN’S ID
AFFIDAVIT OF CONSENT TO
TRAVEL/SPECIAL POWER OF
ATTORNEY
COURT DECREE ON
ADOPTION/GUARDIANSHIP
Others: ______________________
PROCESSOR’S
SIGNATURE:
WATCHLIST
VERIFICATION:
Parent or Legal Guardian’s Signature to receive:
BORROWED
PASSPORT
CANCELLED
PASSPORT
NEW PASSPORT
REMARKS:
SIGNATURE
ENCODER:
SIGNING OFFICER:
END
liability & agree not to sue the Philippine Embassy in Ottawa or any of its officers & staff or its agents/representatives for
any personal injury, expense, loss or damage that I may suffer or sustain as a result or by reason of the mailing of my
passport/documents using the services of Canada Post or courier.
Page 2 of 2
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Form No. 3 ENGLISH: REGULAR PASSPORT APPLICATION FORM (gov)

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Completed 11 July 2022

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