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    Lost Regular Passport Application Form (Adult) : Department of Foreign Affairs

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    prince olan
    This document is a lost passport application form from the Department of Foreign Affairs of the Philippines. It requests information such as the applicant's name, date of birth, contact details, parental information, and previous passport details. The applicant must declare that the information provided is true and consents to its verification. They also acknowledge the legal consequences of making false statements or submitting forged documents with the application.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Lost Regular Passport Application Form (Adult) : Department of Foreign Affairs

    Uploaded by

    prince olan
    21 views2 pages
    This document is a lost passport application form from the Department of Foreign Affairs of the Philippines. It requests information such as the applicant's name, date of birth, contact details, parental information, and previous passport details. The applicant must declare that the information provided is true and consents to its verification. They also acknowledge the legal consequences of making false statements or submitting forged documents with the application.

    Original Title

    00002023012000103

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    This document is a lost passport application form from the Department of Foreign Affairs of the Philippines. It requests information such as the applicant's name, date of birth, contact details, parental information, and previous passport details. The applicant must declare that the information provided is true and consents to its verification. They also acknowledge the legal consequences of making false statements or submitting forged documents with the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views2 pages

    Lost Regular Passport Application Form (Adult) : Department of Foreign Affairs

    Uploaded by

    prince olan
    This document is a lost passport application form from the Department of Foreign Affairs of the Philippines. It requests information such as the applicant's name, date of birth, contact details, parental information, and previous passport details. The applicant must declare that the information provided is true and consents to its verification. They also acknowledge the legal consequences of making false statements or submitting forged documents with the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Form no.

    1- ENGLISH
    LOST REGULAR PASSPORT APPLICATION FORM (Adult)
    THIS FORM IS NOT FOR SALE
    DEPARTMENT OF FOREIGN AFFAIRS
    Office of Consular Affairs Last Revision: 07 October 2017
    DEPARTMENT OF FOREIGN AFFAIRS
    Office of Consular Affairs Last Revision: 07 October 2017
    INSTRUCTIONS: Please PRINT entries legibly using black or blue ink only. Supply
    the necessary informa on and indicate “N/A” for entries with no answers.
    Check boxes as appropriate.

    CAPTURE SITE PRE-PROCESSING (Do not write on this part)


    APPOINTMENT VERIFICATION: REMARKS:

    PASSPORT APPLICANT'S INFORMATION


    1. LAST NAME mago
    2. FIRST NAME roland
    3. MIDDLE NAME OR MAIDEN LAST NAME
    4. GENDER 5. DATE OF BIRTH (EX. 01 JAN 2017) 6. PLACE OF BIRTH
    MALE 08-Aug-1976 MAKATI CITY
    FEMALE
    7. CIVIL 8A. HOW DID YOU ACQUIRE PHL 8B. DID YOU EVER LOSE YOUR PH
    STATUS CITIZENSHIP? CITIZENSHIP? YES NO
    SINGLE BY BIRTH 8C. ARE YOU CURRENTLY A CITIZEN OF
    MARRIED BY NATURALIZATION ANOTHER COUNTRY? YES NO
    BY RE-ACQUISITION(RA NO. 9225) 8D. IF YES, FROM WHAT COUNTRY?
    WIDOW/ER BY ELECTION 8E. HAVE YOU SERVED IN ANY FOREIGN
    ANNULLED BY LEGISLATION MILITARY? YES NO
    DIVORCED BY MARRIAGE 8D. IF YES, WHAT COUNTRY?

    APPLICANT'S CONTACT INFORMATION


    9A. ADDRESS ABROAD
    9B. ADDRESS IN THE PHILIPPINES
    32 NA SITIO SAN JOSE, ANTIPOLO 1002, PHILIPPINES
    10. TELEPHONE/MOBILE NUMBER 09913544176
    11. EMAIL ADDRESS [email protected]
    12. APPLICANT'S SPOUSE'S NAME: mago, marites
    13A. PERSON TO CONTACT IN CASE OF EMERGENCY: mago, marites
    13B. TEL/MOBILE NO.: 09453618862
    PARENTAL INFORMATION PARENTAL INFORMATION
    14. FATHER'S DETAILS 15. MOTHER'S DETAILS 16A. PASSPORT NUMBER
    LAST NAME: LAST NAME:
    mago tombocon
    FIRST NAME: FIRST NAME: 16B. DATE OF ISSUE:
    roberto mago
    MIDDLE NAME: MIDDLE NAME: 16C. DATE OF EXPIRY:
    CITIZENSHIP: (at time of CITIZENSHIP: (at time of 16D. ISSUING AUTHORITY:
    applicant's birth) applicant's birth)
    Philippines Philippines
    STATUS OF CURRENT PASSPORT
    19. PLEASE CHOOSE AS APPLICABLE: STATUS OF CURRENT PASSPORT
    PASSPORT INTACT LOST VALID PASSPORT
    DAMAGED PASSPORT Affidavit of Loss
    Affidavit of Explanation Police Report in English

    LOST EXPIRED PASSPORT


    Affidavit of Explanation

    DECLARATION OF APPLICANT
    I HEREBY DECLARE AND AFFIRM that 1) I am a Filipino citizen. 2) The information provided in
    this application is 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 my personal particulars, and further consent to 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, I am allowed to hold
    only 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 that 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)
    DO NOT WRITE BELOW THIS LINE. FOR THE DEPARTMENT’S USE ONLY.
    REMARKS: PASSPORT WATCHLIST RETURNED CANCELLED
    VERIFICATION: PASSPORT: SIGNATURE
    OF APPLICANT:
    PROCESSOR'S SIGNATURE: ENCODER'S SIGNATURE:

    OFFICIAL RECEIPT/PAYMENT SLIP NO.: DATE OF TRANSACTION:

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