Philippine Consulate General, Los Angeles (Post, RCO or SO)
Request for Revalidation/Extension of Validity of Passport
I, (name)____________________________________________________________ resident of
(First Name) (Middle Name) (Last Name)
______________________________________________________________ hereby request
for the validation / extension of my current Philippine passport, No. ____________________,
issued in __________________________, and expiring / has expired on __________________.
I am making this request in view of the urgency of my travel due to (cite reason for urgency)
I understand that I may encounter difficulties in the port of entry of the country/ies I will be visiting.
I will (check the appropriate box):
Immediately apply for renewal of my revalidated / extended passport upon the
completion of my travel (if not yet applied for passport renewal).
Submit my revalidated / extended passport to PCG Los Angeles for cancellation
upon release of the new passport that I have applied for (if already applied for
passport renewal).
Signature of Applicant: _______________________
Date: _______________________
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