DEPARTMENT OF FOREIGN AFFAIRS

MANILA
E-PASSPORT APPLICATION

PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK

LAST NAME/APELYIDO MIDDLE NAME (GITNANG PANGALAN

FIRST NAME/PANGALAN (JR./II/III) PLACE OF BIRTH/POOK NG KAPANG

DATE OF BIRTH/(Ex. 01-January-2000) GENDER/KASARIAN

PETSA NG KAPANGANAKAN

Civil status: SINGLE MARRIED WIDOW/ER LEGALLY SEPARATED

Name of Wife/Husband:
First Name Middle Name Last Na
Citizenship:
Complete Address:

Tel. No. (home): Mobile No.:

Present Occupation: Tel. No. (office):

Company Name & Address:

E-mail Address:

Name of Father:
First Name Middle Name Last Na
Citizenship:
Maiden/single
Name of Mother:
First Name Middle Name Last Na
Citizenship:
Citizenship Acquired by:
Birth Election Marriage Naturalization
R.A. 9225 Others (specify)
Purpose of Travel
Tour Seaman Business Migration
Study Work Others (specify)

Are you a holder of a foreign passport? yes no

if yes, from what country?

Have you ever been issued a yes no If yes, latest passport no:
Philippine passport? Date issued:
Place issued:

This serves as Affidavit of Support and Consent to Travel

(for applicants below 18 years old ONLY)
Name of minor's traveling companion:
Companion's relationship:
Address/Contact Number:

This serves as Affidavit of Loss

Loss Passport Number Issued on:
Lost due to: Issued by:
 DRAFT ONLY

ITNANG PANGALAN)

POOK NG KAPANGANAKAN

AN

ANNULED

Last Name

Last Name

Last Name