FA FORM NO.

40 THIS FORM IS NOT FOR SALE

( Est. April 1947 )

FOREIGN SERVICE OF THE PHILIPPINES

PHILIPPINE CONSULATE GENERAL, JEDDAH
REPORT OF BIRTH
CHILD BORN ABROAD OF PHILIPPINE PARENT OR PARENTS

Place and Date of Report

Name of Child in Full :

(FN) (MN) (LN)

Date of Birth : Sex :

Place of Birth :
Civil Status of Parents :

FATHER MOTHER

Full Name : | Full Name:

Nationality : Religion : | Name Before Marriage :
Date of Birth : | Nationality : Religion :
Occupation : | Date of Birth :
Present Residence : | Occupation :
Birthplace : | Present Residence :
Naturalized : | Birthplace :
( if foreign born ) : | Naturalized :
Registered as Philippine Citizen at: | ( if foreign born ):
On | Registered as Philippine Citizen at:
Passport Number : | On
Issued by: Dated: | Passport Number :
Valid to : | Issued by : Dated :
Precise Periods and Places of Philippine residence : | Valid to :
| Precise Periods and Places of Philippine Residence:
|

Place and Date of Marriage:

Number of Previous Children: Number Now Living:
Name and Address of Physician:

(Signature of parents, physician or nurse)

(WHEN REPORTED BY MAIL, SIGN IN THE (WHEN REPORTED INPERSON, USE THIS FORM)
PRESENCE OF TWO WITNESSES)
Declared to in our presence this: Subscribed and Sworn to before me this:
Day of: ,20 Day of:
(Witnesses)
(Witnesses)

(SEAL)

Doc. No.:
Serv. No.
Series of : PHILIPPINE CONSULATE GENERAL
O.R. No. :
At Philippine Consulate General, Jeddah, KSA

20
The foregoing information was furnished by (father, mother, physician, nurse) and supported by (affidavit,
physician’s certificate from local authorities.) This report has been executed in triplicate copy issued to parents, copy
transmitted to the Department of Foreign Affairs, Manila, and placed in the filed of this office.

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