Note: Indicate N/A if

Not applicable. Print all

Information. To be filled
In duplicate.

Republic of the Philippines

Embassy of the Philippines

BRASILIA, BRAZIL

APPLICATION/PETITION FORM
CITIZENSHIP RETENTION AND RE-ACQUISITION
(Under R.A. 9225)
I, __________________________________________hereby petition the Philippine
Embassy, Brasilia, to evaluate and approve my application to reacquire/retain Philippine
Citizenship under R.A. 9225 (Citizenship Retention and Reacquisition Act of 2003) and its
implementing Rules and Regulations (IRR).

Attach one (1) passport size

colored photo with
White background,
WITHOUT eyeglasses.

The following are my personal details:

1. LAST NAME
2. FIRST NAME (Given name(s) written on birth certificate
3. MIDDLE NAME/MAIDEN NAME
4. OTHER NAMES USED
6. DATE OF BIRTH

Day

Month

Year

7. PLACE OF BIRTH (Town or City, Province, State, Country)

8. HEIGHT (Feet)

9. WEIGHT(Kgs.)

5. GENDER:
[ ] MALE
[ ] FEMALE
12. CIVIL STATUS

10. HAIR COLOR

11. EYE COLOR

13. DISTINGUISHING MARKS ON FACE

[]
[]
[]
[]
[]

SINGLE
MARRIED
WIDOWED
DIVORCED
LEGALLY
SEPARATED

14. HOW PHILIPPPINE CITIZENSHIP WAS ACQUIRED

[ ] Birth
[ ] Election
[ ] Naturalization
[ ] Others ____________________
15. PREVIOUS PHILIPPIN PASSPORT NUMBER
16. DATE AND PLACE OF ISSUE OF PHILIPPINE PPT.
17. ACR/ICR NUMBER (If applicable)

18. DATE OF ISSUE OF ACR/ICR

19. FOREIGN PASSPORT NUMBER

20. DATE AND PACE OF ISSUE OF FOREIGN PASSPORT

21. CURRENT FOREIGN CITIZENSHIP

22. MODE OF ACQUISITION OF FOREIGN CITIZENSHIP

23. DATE OF ACQUISITION OF FOREIGN CITIZENSHIP

24. NATURALIZATION CERTIFICATE NO.

25. NAME AND ADDRESS OF SPOUSE, OR IF WIDOWED, NAME OF DECEASED SPOUSE

26. CITIZENSHIP

27. NAME OF APPLICANTS FATHER (First Name, Full Middle Name, Last Name)

28. CITIZENSHIP*

29. NAME OF APPLICANTS MOTHER (First Name, Full Middle Name, Maiden/Last Name

30. CITIZENSHIP*

*Refers to citizenship of parents at the time of applicants birth or as indicated in applicants birth certificate.

31.( PHILIPPINE ADDRESS: House No. Street, Town or City, State, Country, Postal Zone)

32. CURRENT ADDRESS ABROAD: (House No., Street, Town or City, State, Country, Postal Zone

33. CONTACT TELEPHONE No. (Include Area

Code)
35. NAME OF MINOR CHILD TO BE
INCLUDED IN THE APPLICATION

36. CIVIL
STATUS

34. EMAIL ADDRESS/Work Tel. No.

37. AGE

38. DATE AND PLACE OF BIRTH

(City/Suburb, State, Country)

39. HAVE YOU BEEN CONVICTED OF ANY CRIME OR CHARGED WITH AN ADMINISTRATIVE OFFENSE?
IF YES, PLEASE PROVIDE DETAILS.
___________________________________________________________________________________________

CERTIFICATION
I hereby certify under oath that all the information in this general application form composing of two
pages including the page on which this Certification is written are true and correct information about
myself as an applicant. I further warrant that I have complied with all the requirements with respect to
my application for the issuance of an Identification Certificate (I.C.) and that I submitted copies of
documents issued by the office having legal custody of their originals in the Philippines and foreign
documents with their official translation into English, when applicable, in compliance with the
requirements. I understand that my application will not be processed if it finds any statement herein to
be false, if any document submitted is found to have been falsified, or if I fail to comply with all the
requirements with respect to my application/petition without prejudice to whatever action (s) the
Philippine Government agencies shall take in accordance with applicable laws of the Republic of the
Philippines.
_______________________________
DATE
___________________________________
APPLICANTS SIGNATURE OVER PRINTED NAME
Embassy of the Philippines )
Consular Section
) S.S.
BRASILIA, D.F.
)

SUBSCRIBED AND SWORN /AFFIRMED to before me this ___________ day of

__________________________ 20___.

_________________________________
NAME AND SIGNATURE OF PERSON ADMINISTERING OATH

EMBAIXADA DA REPBLICA DAS FILIPINAS

SEN Av. das Naes Lt. 1 Braslia DF Brasil CEP:70431-900
Fone: (61) 3224-8694 Fax: (61) 3226-7411 E-Mail: brasiliape@brturbo.com.br
Expediente Segunda a Sexta : 9:00-17:00h

CHECKLIST OF REQUIREMENTS FOR APPLICATIONS

TO REACQUIRE AND/OR RETAIN DUAL CITIZENSHIP

1. Application/Petition Form ( to be filled-out in triplicate)

2. Proof of Philippine Citizenship

Original Philippine Birth Certificate

Old Philippine Passport (if available)
Voters affidavit or voters identification card (if available)
Marriage contract indicating the Philippine citizenship of the applicant (if available); and
Such other documents that would show that the applicant is a former natural-born citizen of
the Philippines as may be acceptable to the evaluating officer.

All of the above-mentioned documents should be presented in their original copies, to be

returned to the applicant after their authenticity has been verified.
If born outside the Philippines, Report of Birth (ROB) issued by the Philippine
Embassy/Consulate.
In all cases, the evaluating officer may require the submission of additional documents if
there is reasonable ground to believe that the applicant is not a former natural-born
Filipino.
3. Proof of Foreign Citizenship

Original Certificate of Naturalization

Original Foreign Passport (if available)

4. Proof of Civil Status

Marriage Certificate, if married

Death Certificate of spouse, if widowed/widower
Annulment decree, if marriage has been annulled
Divorce decree, if divorced

5. Application/Petition with Dependents below 18 years of age

Please refer to Nos. 2 and 3 above.

If the child is adopted, adoption decree

6. Photos
Three (3) passport-sized colored photos with plain white background, no eyeglasses. The
same requirement is required of dependents.
7. Processing Fee

Application/Petition for Principal US$50.00 or R$110.00

Application/Petition for Each Dependent US$25.00 or R$55.00

The fees may be paid prior to taking the Oath of Allegiance of the applicant at the Embassy.
8. Personal appearance of the applicant at the Embassy in Brasilia to take the Oath of Allegiance
before the Consular Officer. The date of personal appearance and oath-taking at the Embassy
shall be set after the completion of evaluation of documents showing that the applicant has
complied with all the requirements.
NOTE: Please bring all original documents. Applicant must submit three (3) photocopies of all original
documents. Additional documentation may be required by the Consular Officer.