PID Form No.

Re p u b l i c o f t h e P h i l i p p i n e s
Revision (No.) (Date)
PHILIPPINE POSTAL CORPORATION Application Control No.:

APPLICATION FOR POSTAL ID CARD Accepting Post Office Code:

Accepting Post Office Name:
OR No: OR Date:
ALL FIELDS WITH ( ) ARE REQUIRED PLEASE READ THE GENERAL TERMS AND CONDITIONS AT THE BACK BEFORE ACCOMPLISHING
POSTAL REFERENCE NO. (Leave blank if New Application)
THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY.

PART I - TO BE FILLED OUT BY THE APPLICANT

A. APPLICATION TYPE
PURPOSE / INITIAL CARD REPLACEMENT
Amendment of Name Amendment of Biographic Data Replacement of Damaged Card
RENEWAL
Replacement of Lost Card Amendment of Authenticating Finger Others

B. APPLICANT DETAILS
APPLICANT’S NAME (FIRST NAME) (MIDDLE NAME) (LAST NAME) (SUFFIX)
DELILAH JUANCO AZORES
GENDER DATE OF BIRTH (MM/DD/YYYY) PLACE OF BIRTH (CITY/MUNICIPALITY) (PROVINCE) (COUNTRY)

FEMALE 0 4 2 2 2 0 0 0 E NR I L E C A G AYA N P H I L I P P I NE S
FATHER’S NAME (FIRST NAME) (MIDDLE NAME) (LAST NAME) (SUFFIX)
ROMEO CALUSIN AZORES
MOTHER’S MAIDEN NAME (FIRST NAME)
DELIA
(MIDDLE NAME)
DAGDAG
(LAST NAME)
JUANCO (SUFFIX)

NATIONALITY OCCUPATION CIVIL STATUS

FILIPINO STUDENT / Single Married Widowed Separated Divorced/Annulled
GSIS No.(If GSIS member) SSS No.(If SSS member) TIN No.(If Available)

CRN No.(If Available) PHILHEALTH No.(If member) HDMF No.(If member)

EYES (COLOR) HAIR (NATURAL COLOR) COMPLEXION TELEPHONE NUMBER MOBILE NUMBER

DISTINGUISHING FACIAL FEATURES WEIGHT (KILOS) HEIGHT (CENTIMETERS) EMAIL ADDRESS

C. ADDRESS DETAILS
PREFERRED MAILING ADDRESS (CHOOSE ONE) / PRESENT WORK
PRESENT ADDRESS
(RM/FLR/UNIT NO./ BLDG. NAME) (HOUSE/ LOT & BLK NO.) (STREET NAME)
Z ONE 2
(SUBDIVISION) (BARANGAY/DISTRICT/LOCALITY)
R O MA S U R
(CITY/MUNICIPALITY) (PROVINCE) (COUNTRY) (POST CODE)
ENRILE CAGAYAN PHILIPPINES 3 5 0 1
WORK ADDRESS
EMPLOYMENT STATUS COMPANY TYPE
Contractual Regular / Permanent Household Self Employed OFW Government Private Others
(COMPANY/RM/FLR/UNIT NO./BLDG. NAME) (HOUSE / LOT & BLK NO.) (STREET NAME)

(SUBDIVISION) (BARANGAY/DISTRICT/LOCALITY)

(CITY/MUNICIPALITY) (PROVINCE) (COUNTRY) (POST CODE)

D. APPLICANT’S CERTIFICATION
N ot w it hst anding t he confi den t i a l i t y o f t he da t a t ha t I ha v e suppl i e d he re i n, I he r eby give my Fur ther, all s tatements / data on the FINGERPRINTS IF APPLICANT CANNOT SIGN:
consent t hat t he same be sec ure d a nd a c c e sse d f o r subse que nt v a l i da t i o n, v e rifi cation, and oper ator 's s cr een, which wer e s hown to me
other purposes consist ent w i t h t he o bj e c t i v e s o f t hi s c a rd e nro l l m e nt . I f urt her affi r m that at or about the time I affi xed my s ignatur e
by af fi xing my signat ure on t hi s f o rm , a l l st a t e m e nt s/da t a a ppe a ri ng i n t hi s f or m ar e tr ue, her ein, ar e tr ue, cor r ect and complete to the
correct and complet e. While a ppl y i ng f o r t hi s c a rd, I l i k e w i se f ul l y a gre e t o a nd under s tand bes t of my knowledge and belief.
all t he t erms of it s issuance a s go v e rne d by P o st a l rul e s a nd re gul a t i o ns.
Higit pa r ito, ang aking lagda s a for m na ito
Ibi nibigay ko ang aking pahi nt ul o t na ga m i t i n a ng m ga k o m pi de nsy a l na i mpor mas yong ay nagpapatunay na ang lahat ng
nakasaad sa it aas sa pagpapa t una y, pa gbe be ri pi k a a t i ba pa ng pa m a m a ra a ng kaugnay s a impor mas yong makikita s a kompyuter s cr een
pr oseso ng paggaw a ng Post a l I D . Ang a k i ng l a gda sa f o rm na i t o a y na gpa pa tibay na ang ng oper ator ay totoo, tama at kumpleto s a
lahat ng impormasyong maki k i t a sa f o rm na i t o a y t o t o o , t a m a a t k um pl e t o . N a iintidihan ko aking buong kaalaman at paniniwala.
r in at sumasang-ayon ako sa m ga a l i t unt uni n a t re gl a m e nt o na sum a sa k l a w sa pagkakar oon
ng Post al ID card. RIGHT THUMB RIGHT INDEX

APPLICANT’S SIGNATURE APPLICANT’S SIGNATURE WITNESS’ SIGNATURE

DELILAH J. AZORES AUG. 14, 2020 DELILAHH J. AZORES 08-14-2020

SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME

PART II - TO BE FILLED OUT BY PHLPOST

SUPPORTING DOCUMENTS PRESENTED: APPROVED BY:
NSO Birth Certificate Barangay Certificate
/ Others SIGNATURE OVER PRINTED NAME DATE
DATA CAPTURE SCHEDULE DATA CAPTURED BY:
DATE
SCREENED BY: Capturing Post Office Name / Code:

SIGNATURE OVER PRINTED NAME DATE Date / Time: SIGNATURE OVER PRINTED NAME
TEAR HERE
Re p u b l i c o f t h e P h i l i p p i n e s Application Control No.:
PHILIPPINE POSTAL CORPORATION Accepting Post Office Code:

APPLICATION FOR POSTAL ID CARD AC K N OW LE D GE M E N T S L IP ( C L IENT CO PY )

Accepting Post Office Name:
OR No : OR Date:

POSTAL REFERENCE NO. (Leave blank if New Application) NAME (FIRST NAME) (MIDDLE NAME) (LAST NAME) (SUFFIX)

APPROVED BY: DATA CAPTURE SCHEDULE: DATA CAPTURED BY:

Capturing Post Office Name / Code:

SIGNATURE OVER PRINTED NAME DATE Date / Time: SIGNATURE OVER PRINTED NAME DATE