Important Reminders!!!!!!!Your appointment is onThu, Jan 22, 2015 at 03:00 pm.Please be at DFA-NCR West (SM City Manila) by 03:00 pm.Please make sure you have prepared all the requirements.You can view the list at www.manila.passport.com.phPlease make sure to photocopy all of your requirements.Applicants without a complete set of photocopies will not be entertained.For your NSO certificate requirements, you may call (02) 737-1111.Nationwide delivery within 3-4 days.You may have your passport delivered for extra convenience.Please prepare extra P120 for the delivery fee.Please print this page and the application form on LONG BOND PAPER.Applicants without the printed application form will not be allowed entry at the DFA.Please complete the application form before going to the DFA.For questions or concerns, you may email info@passport.com.ph.Thank you for using the DFA Passport Appointment System.REPUBLC OF THE PHLPPNESDEPARTMENT OF FOREIGN AFFAIRSMANLAE-PASSPORT APPLICATIONPLEASE PROVDE CORRECT NFORMATON AND DO NOT LEAVE SPACES BLANKLAST NAME / APELYDOMDDLE NAME / GTNANG PANGALANDATE OF BRTH (Ex. Day/Month/Year)FRST NAME / PANGALAN (Jr. / / )PLACE OF BRTH / POOK NG KAPANGANAKANGENDER / KASARANCivil Status: Single Married Widow/er Legally Separated AnnulledName of Wife / Husband: Citizenship:Complete Address: Tel. No:Present Occupation: Mobile No:Work Address:Email Address: Office No:Name of Father: Citizenship:Maiden/Single Name ofMother:Citizenship:Citizenship Acquired By:Birth Election Marriage NaturalizationR.A.9225 Others: ________________________Purpose of Travel:Tour Seaman Business MigrationStudy Work Others: ______________Are you a holder of a foreign passport?Yes Nof Yes, from what country? ___________________Have you ever been issued a Philippine Passport?Yes Nof Yes, latest passport number? _______________Date of issue ________ Place of issue _________SOLEMNLY SWEAR that 1) am a Filipino citizen. 2) The information provided in this application is true and correct. 3) The supportingdocuments attached are authentic. 4) have not been issued a passport under any other name. 5) am aware that under the law, amallowed to hold only one Philippine passport at any given time. 6) am aware that making false statements in passport application furnishingfalsified or forged documents in support thereof are punishable by law.FOR STRCT COMPLANCE: Please print name and affix initials.Processor:Encoder:Signing Officer:RECEVED CANCELLED PASSPORT: RECEVED NEW PASSPORT:FOR ADMNSTRATVE USE ONLY:Name of Wife / Husband: Citizenship:Complete Address: Tel. No:Present Occupation: Mobile No:Work Address:Email Address: Office No:( For appIicants beIow 18 years oId ONLY )Name of minor's travelling companion: Companion's relationship: Contact Number: Signature of Applicant or Legal Guardian (for minor applicants)FOR USE OF THE DEPARTMENT OF FOREGN AFFARS ONLY. PLEASE DO NOT WRTE BELOW THS LNEREMARKS:Thu, Jan 22, 2015 03:00 pmJACKELYNOCAMPOMARIANOFEMALE 10/AUG/1980ROXAS ISABELAOSCAR ALONZO MARIANO FILIPINOJAFFNIX@YAHOO.COMBRGY. VILLA CONCEPCION, ROXAS, ISABELA, ROXAS ISABELA0999561142009995611420ROBERTO PAGUYO OCAMPO FILIPNOLEONILA CADAUAN SAMUT FILIPINOXXX2185041DFA CONSULAR OFFICE TUGUEGARAO 03/15/2010XXXX"To our valued clients:To ensure quality service, this transaction may be recorded. Thank you for your understanding and support.(Sa aming mga iginagalang na aplikante:Para matiyak ang maayos na kalidad ng aming serbisyo, ang transakyong ito ay maaring i-rekord.Maraming salamat sa inyong pang-unawa at suporta.)"Wed, Jan 07, 2015 01:14 pm01e32084c2d3961f0bb2caa17696a574a0ea8bf9!"#$%!"&"'() +,! +%!)( (%&" -.))-,!( .--/%0.'() -1234567 6881626591 045:;2'4 511= >4 3?@ 6 8633842> 3;A1 8B4>4 C?7D 6994;45 :42< - !"# %& '()*+("'&' ,-(! ./& 012 )&%34.&5 !!!"#$%"&'(")* E;2>B 012>;:;96>1 (BC) in Secuiity Papei (SECPA) issueu by the '6>;4567 )>6>;3>;93 ,::;91 (NS0) oi Ceitifieu Tiue Copy (CTC) of BC issueu by the Local Civil Registiai (LCR) & uuly authenticateu by NS0. Tiansciibeu BC fiom the LCR is iequiieu when entiies in NS0 BC aie bluiieu oi unieauable. Repoit of Biith uuly authenticateu by NS0 is iequiieu if boin abioau. F67;=8;9>?21%C365=3?8842>;5G=49?3>4824H1;=15>;>D(pleaseiefeitotheListofAcceptableIBs&Suppoiting Bocuments below) %5 0631 4: '4 E;2>B !1942=I %: @425 ;5 42 6:>12 JKLM NO65?62D JP JKLM 42 6:>12QI Apply foi the uelayeu iegistiation of biith at the local civil iegistiy office locateu at the place of biith of applicant SubmitauthenticateuBiith CeitificatefiomNS0anusuppoitingpublicuocumentsupontheuiscietionofthepiocessoioi Consulai 0fficei, with coiiect uate anu place of biith {i.e. Iorm 1S7, voters Reqistrotion RecorJ, Boptismol Certificote witb -&"'"%+& '-# 3&"+ (- 6781 9 :82 7&-.4,4;".& )4./ ;A153B;8 42 6887;965>3 R;>B $'+,-&./0'1.#-.& $%3-45 .%3,0 N1VGV /%&P 0W,P )XP /""P ).&.C%P )%'YWP 1>9VQI Buieau of Immigiation Iuentification Ceitificate Ceitificate of Natuialization Election of Filipino Citizenship 0ath of Allegiance IF NECESSARY, Naiiiage Ceitificate of paients (uuly authenticateu by NS0) NS0 Biith Ceitificate of applicant's biothei oi sistei .887;965>3 RB4 6H6;71= 4: 61%4 7-8-9,.0*-) 42 :4,;8-'. '$ ;3 6 C,)( 39B4762I (same geneial iequiiements stateu above) Secuie a ceitification oi cleaiance fiom B0ST +42 &;542 .887;965>3 N@174R J[ D1623 47== Confiimeu appointment (except foi 1 yeai olu anu below) Peisonal appeaiance of the minoi applicant Peisonal appeaiance of eithei paient, NS0 Naiiiage Contiact anu piopei IB valiu passpoit of paients (if minoi is a legitimate chilu) Peisonal appeaiance of mothei anu piopei IB valiu passpoit ofmothei (if minoi is an illegitimate chilu) 0iiginal anu photocopy ofvaliu passpoit of the peison tiaveling with the minoi Notaiizeu Affiuavit of Suppoit anu Consent to tiavel fiom eithei paient (if minoi is a legitimate chilu) fiom mothei (if minoi is an illegitimate chilu) 0iiginal E;2>B 012>;:;96>1 (BC) of minoi in Secuiity Papei issueu by NS0 oi Ceitifieu Tiue Copy of BC issueu by the LCR & uulyauthenticateubyNS0.TiansciibeuBCfiomtheLCRisiequiieuwhenentiiesinNS0BCaiebluiieuoiunieauable. Repoit of Biith uuly authenticateu by NS0 is iequiieu if minoi was boin abioau. Bocument of iuentity with photo, if minoi is 8-17 yeais olu (foi fiist time & ienewal applicant) such as School I.B. oi Foim 1S7 with ieauable uiy seal. Foi minoi applicants who nevei attenueu school, a Notaiizeu Affiuavit of Explanation executeu by eithei paient (if minoi is a legitimate chilu) by mothei (if minoi is an illegitimate chilu)uetailing the ieasons why the chilu is not in school, is iequiieu .==;>;4567 !1U?;213%: >26H17;5G R;>B 1;>B12 86215> 42 67451I Peisonal appeaiance of the mothei is iequiieu if minoi applicant is an illegitimate chilu. AffiuavitofSuppoitanuConsent(ASC)executeubyeitheipaientinuicatingthenameofthetiavelingcompanionanu ielationship to the minoi. If minoi will be tiaveling alone, ASC must be executeu by eithei paient, stating that hishei chilu will betiaveling alone. If minoi is illegitimate, mothei shoulu execute the ASC. 0iiginalanuphotocopyofBSWBCleaiance.TheieisnoneeutosecuieaBSWBCleaianceiftheminoitiavelingabioauhas paientswhoaieintheFoieignSeiviceoilivingabioau oiaieimmigiants,pioviueuhesheisholuingavaliupasssuchasa uepenuent's visa pass iuentification caiu oi peimanent iesiuent visa pass iuentification caiu which seives as pioof that he she is living with paients abioau. %: @4>B 86215>3 621 6@246=I Affiuavit of Suppoit anu Consent (ASC) executeu by eithei paient inuicating the name of the tiaveling companion (authenticateuby the neaiest Philippine Embassy oi Consulate ueneial). If minoi is illegitimate, mothei shoulu execute the ASC. SpecialPoweiofAttoiney(SPA)withanattacheuphotocopyofeitheipaient'svaliupasspoit(authenticateubytheneaiest PhilippineEmbassyoi Consulateueneial) authoiizingaiepiesentativein assistingthe chiluto applyfoiapasspoit.If minoiis illegitimate, mothei shoulu execute the SPA. 0iiginalanuphotocopyofBSWBCleaiance.TheieisnoneeutosecuieaBSWBCleaianceiftheminoitiavelingabioauhas paientswhoaieintheFoieignSeiviceoilivingabioau oiaieimmigiants,pioviueuhesheisholuingavaliupasssuchasa uepenuent's visa pass iuentification caiu oi peimanent iesiuent visa pass iuentification caiu which seives as pioof that he she is living with paients abioau. Piopei IB of the uuly authoiizeu iepiesentative (Please iefei to List of Acceptable IBs) %: ;1= @D 3?@31U?15> 3I Authenticateu Biith Ceitificate fiom NS0 with annotation iegaiuing new status as legitimateu anu the full name of the chilu %: ;1 @?> 69\54R71=G1= @D :6>B12I Biith ceitificate fiom NS0 ieflecting suiname of fathei with Affiuavit of Acknowleugement anu Consent to use suiname of fathei ,28B651= I Authenticateu Beath Ceitificates of paients fiom NS0 Couit oiuei awaiuing guaiuianship of the oiphaneu minoi applicant oi substitute paiental authoiity unuei Aiticle 214 & 216 of the Family Coue BSWB Cleaiance .@65=451= I Couit oiuei awaiuing guaiuianship of the abanuoneu minoi applicant oisubstitute paiental authoiity BSWB Tiavel Cleaiance +4?5=7;5GI Ceitificate of founuling authenticateu by NS0 BSWB Cleaiance Passpoit of the peison who founu the applicant Lettei of authoiity oi enuoisement fiom BSWB foi the issuance of passpoit /1G677D 6=48>1=I 0iiginal anu Ceitifieu Tiue Copy (CTC) of NS0 Biith Ceitificate befoie auoption 0iiginal anu Ceitifieu Tiue Copy (CTC) of the NS0 amenueu Biith Ceitificate aftei auoption Ceitifieu Tiue Copy (CTC) of the Couit Becision oi 0iuei on Auoption anu Ceitificate of Finality BSWB cleaiance foi minoi applicant, if tiaveling with the peison othei than the auopting paients C* ;"3& ./& "3 621 655?771= ] =;H4291=I Couit oiuei awaiuing guaiuianship of the minoi applicant oi substitute paiental authoiity BSWB Tiavel Cleaiance NS0 Naiiiage Ceitificate with annotation on nullity oi annulment ueciee &;542 6887;965> RB431 B12 ;3 7;\1R;31 6 3 (same geneial iequiiements stateu above) +42 76>1 21G;3>121= &?37;< 6887;965>3I Ceitificate of Tiibal Affiliation fiom the National Commission on Nuslim Filipinos (NCNF) +42 945H12>3 RB4 R4?7= 7;\1 >4 ?31 >B1;2 &?37;< 56;4567)>6>;3>;93,::;91(NS0)oiCeitifieuTiueCopy (CTC) of BC issueu by the Local Civil Registiai (LCR) to ueteimine complete place of biith. Tiansciibeu Biith Ceitificate fiom the LCR is iequiieu when entiies in NS0 Biith Ceitificate aie bluiieu oi unieauable 0lu cancelleu passpoit may also be piesenteu in the absence of an NS0 Biith Ceitificate "719>245;9 -633842> N"a8633842>Q Biing oiiginal e-passpoit anu photocopy of fiist (uata page) anu last page of passpoit +42 B1;2 4 ?31 >B1;2 $ 3%++-%&, -0 %..144,#E Ceitifieu Tiue Copy of annotateu NS0 Naiiiage Contiact anu Couit 0iuei effecting the annulment. >$#-('+;,#E CeitifieuTiueCopyoftheBivoiceBecieeuulyauthenticateubythePhilippineEmbassyoi Consulatewheiethe uivoicewasobtaineuoibytheconceineufoieignuiplomaticoiconsulaimissionin thePhilippines.0iiginalanuCTCofPhil. Couit iecognition of foieign uivoice ueciee must also be piesent anu the NS0 NC with the annotation of the Bivoice Beciee. +423,iequiiementsfoifiisttimeminoiapplicantsaiestillpiesciibeu,inauuitiontothepasspoitof minoi. +42 &?37;< .887;965>3 (same geneial iequiiements stateu above) +42 945H12>3 RB4 R4?7= 7;\1 >4 ?31 >B1;2 &?37;< 56;A153B;8426887;965>3R;>B$'+,-&./0'1.#-.&$%3-45.%3,0N1VGV/%&P0W,P)XP/""P ).&.C%P )%'YWP 1>9VQI Buieau of Immigiation Iuentification CeitificateIF NECESSARY, Ceitificate of NatuializationNS0 Naiiiage Ceitificate of paients Election of Filipino Citizenship 0ath of Allegiance NS0 Biith Ceitificate of applicant oi applicant's biothei sistei .887;965>3 RB4 6H6;71= 4: 61%4 7-8-9,.0*-) 42 :4,;8-'. '$ ;3 6 C,)( )9B4762 (same geneial iequiiements stateu above): Secuie a ceitification oi cleaiance fiom B0ST !"#$%!"&"'() +,! !"-/.0"&"'( ,+ /,)( -.))-,!() -1234567 6881626591 045:;2'4 511= >4 3?@ 6 8633842> 3;A1 8B4>4 C?7D 6994;45 :42< - !"# %& '()*+("'&' ,-(! ./& 012 )&%34.&5 !!!"#$%"&'(")* /%)( ,+ .00"-(.E/" %C) N.> 7163> J 4: >B1 :4774R;5GQI Y4H125a;33?1= %C3 such as uigitizeu SSS IB, Biivei's License, uSIS E-caiu, PRC IB, IBP IB, 0WWA IB, uigitizeu BIR IB, Senioi Citizen's IB. ,>B12 69918>6@71 8;9>?21 %C3 incluue olu College IB, Alumni IB, oi olu Employment IBs /%)( ,+ )$--,!(%'Y C,0$&"'() N.> 7163> S 4: >B1 :4774R;5GQI votei's IB NS0 Naiiiage Contiact Lanu Title Seaman's Book Elementaiy oi Bigh School Foim 1S7 oi Tiansciipt of Recoius with ieauable uiy seal uoveinment Seivice Recoiu NBI Cleaiance Police Cleaiance Baiangay Cleaiance 0lu uocuments issueu at least one yeai piioi to uate of application that show coiiect name, uate anu place of biith, pictuie anu signatuie of applicant such as: NS0 Biith Ceitificate of chiluchiluien, SSS-E1 Foim oi Niciofilmeu copy of SSS-E1 Foim, Income Tax Retuin, votei's Ceitification, List of voteis anu votei's Registiation Recoiu (foi newly issueu vRR, please attach ieceipt), School Yeaibook, oi Community Tax Ceitificate %5 9631 8633842> R63 743> 65= 96554> @1 :4?5=I Submit '4>62;A1= .::;=6H;> 4: /433 (with uetaileu explanation on when, wheie anu how passpoit got lost). If the lost passpoit is still valiu, submit -47;91 !1842>V Photocopy of fiist page of lost passpoit (if available) F/&-& )4++ %& " ?@/#%5 ;4,%+-.& ),+-'# @?> 1H15>?677D R63 :4?5= 65= 21>?251= >4 B;;76>;45 (with uetaileu explanation on when, wheie anu how passpoit got mutilateu oi uamageu) 0iiginal anu photocopy of fiist anu last page of mutilateu oi uamageu passpoit %5 9631 6887;965> R63 ;33?1= 6 (26H17 C49?I 0iiginal Tiavel Bocument '4>62;A1= .::;=6H;> 4: "_87656>;45 !1G62=;5G %33?6591 4: (26H17 C49? (with uetaileu explanation on when, wheie anuwhy applicant was issueu a tiavel uocument) 0iiginal anu photocopy of fiist anu last page of cancelleu passpoit (if passpoit is still in the possession of the applicant) !"&%'C"!) Peisonal appeaiance is iequiieu foi all applicants Confiimeu appointment is iequiieu foi all applicants except senioi citizens, infants & minois below 1 yeai olu anu 0FWs.Foi 0FWs, sufficient pioof must be submitteu such as valiu employment contiact oi 0EC. Eaiiings & contact lenses aie not alloweu uuiing uata captuiing. Smiling with visible teeth is also not alloweu. Check all uata in the computei monitoi & in the Eniolment Ceitificate befoie signing. 0nly immeuiate family membeis aie alloweu to get the passpoit in behalf of the applicant. Immeuiate family membeis incluuefathei, mothei, biothei, sistei, spouse anu chiluien of legal age. Passpoitshallbeieleaseutoanimmeuiatefamilymembeionlywithpiopeiauthoiizationlettei.Passpoitofaminoiapplicant shall be ieleaseu to paients only oi to an authoiizeu iepiesentative with Special Powei of Attoiney & Affiuavitof Suppoit anu Consent.Passpoits unclaimeu aftei 6 months will be cancelleu pei Bepaitment 0iuei No. S7-uS.Check all uata in the ieceiveu e-passpoit upon ielease. Numbei of piocessing uays may vaiy uepenuing on the location of the Regional Consulai 0ffice wheie the application was fileu. TheBepaitmentmayiequiieauuitionalsuppoitinguocumentsas may benecessaiy,especiallyfoi applicants withuualcitizenship anu with foieign-sounuing family names to piove citizenship. -.))-,!( +"")I !1G?762 -249133;5G(1S woiking uays) : P9Su.uu"_81=;>1= -249133;5G (7 woiking uays): P1,2uu.uu+42 !187691 4: 6 743> H67;= 8633842>: Auuitional fee of P2uu.uu foi a lost valiu NRRPNRP oi PSSu.uu foi a lost valiu e-passpoit .887D:42D4?28633842>1627DP821862121U?;213@1:4216884;5>=6>1P545a,+^65=&1>24&65;76a@631= 6887;965>3 3B4?7= 319?21 65 6884;5> RB15 6887D;5G :42 6 8633842>P >B431 ;5 824H;5913 965 6887D 6> >B1 516213> !1G;4567 0453?762 ,::;91 42 =?2;5G &4@;71 -633842> )12H;91 N&-)QP ,+^3 965 6887D 6> >B1 -633842> "_>153;45 ,::;917496>1= 6> >B1 -,". ;5 ,2>;G63P =4 54> =167 R;>B :;_123P 6H6;7 4: >B1 8633842> =17;H12D 312H;91 b >6\1 G44= 9621 4: D4?2 8633842>V+42946591P871631945>69>>B1-?@7;9.33;3>6591015>1242>B1-633842> Director's Uffice. "#$%&"#'#()* +"# ,+*#- ."/' "0+01234 /" )5# 65&7&66&(# 6+**6/") +8) /. 944: +(- &)* &'67#'#()&(; "%7#* +(- "#;%7+)&/(*0