BI FORM: MCL-08-01

Republic of the Philippines Department of Justice

BUREAU OF IMMIGRATION
Intramuros, Manila CRR No. ______________ In re: Petition for Re-acquisition and/or Retention of Philippine Citizenship u nder Republic Act No. 9225 x----------------------------------------------------------x
(Note: Indicate N/A if not applicable. Do not leave any space blank. Print all information LEGIBLY. Petitions not properly accomplished will not be acted upon.)

Passport size colored photo over royal blue background

P E T I T I O N
I, (Full name of petitioner) FLORENCIO ABEDANIA DULAY , also known as (a.k.a) N/A , of legal age, single/married, a citizen of United States of America and a resident of _________________________________ with contact no. _________________, after being sworn to in accordance with law, hereby declares under oath that: 1. I am a former natural-born Philippine citizen, born on May 29, 1940 at Baguio City, Philippines to (Fathers Name) _______________________, (Fathers citizenship at the time of petitioners birth) Filipino citizen, and (Mothers Name) ______________________________, (Mothers citizenship at the time of petitioners birth) Filipino citizen; 2. I lost my Philippine citizenship where I became a citizen of United States of America on ______________. Presently, I became a holder of ______________________ passport with No. ________________ issued on _______________ at ____________________; 3. I took my oath of allegiance to the Republic of the Philippines on ____________________ at __________________________; 4. (If petitioner is registered alien with the Bureau of Immigration [BI]) I am a holder of Alien Certificate of Registration (ACR) No. N/A and Immigrant Certificate of Residence/Certificate of Residence for Temporary Visitors (ICR/CRTV) No. N/A ; 5. (If with Dependent[s]) Included in this petition is/are my unmarried child/children below eighteen (18) years old, namely: Name Relationship Date of Birth Age _____________________________ _________________ _________________ _______ _____________________________ ________________ _________________ _______ _____________________________ ________________ _________________ _______
(Note: Kindly accomplish BI BORM: MCL-08-02 (Supplement) attached to this petition) for each dependent to be

6. I am freely and voluntarily filing this petition to reacquire my Philippine citizenship knowing fully well its concomitant rights and obligations; 7. This petition with the BI is being filed in accordance with Republic Act No. 9225 and its implementing rules and regulations. WHEREFORE , premises considered, it is most respectfully prayed that this petition for Re-acquisition and/or Retention of Philippine Citizenship under Republic Act No. 9225 be GRANTED .

BAR CODE

__________________________________ (Signature over printed name of the Petitioner)