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Important Reminders

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Your appointment is on Thu, Dec 08, 2011 at 09:30 am.
Please be at DFA Aseana by 09:00 am.
Please make sure you have prepared all the requirements.
You can view the list at www.passport.com.ph
Please 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.
REPUBLIC OF THE PHILIPPINES
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

DATE OF BIRTH (Ex. Day/Month/Year)

FIRST NAME / PANGALAN (Jr. / II / III)

PLACE OF BIRTH / POOK NG KAPANGANAKAN

GENDER / KASARIAN
Civil Status: Single Married Widow/er Legally Separated Annulled
Name 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 of
Mother:
Citizenship:
Citizenship Acquired By:
Birth Election Marriage Naturalization
R.A.9225 Others: ________________________
Purpose of Travel:
Tour Seaman Business Migration
Study Work Others: ______________
Are you a holder of a foreign passport?
Yes No
If Yes, from what country? ___________________
Have you ever been issued a Philippine Passport?
Yes No
If Yes, latest passport number? _______________
Date of issue ________ Place of issue _________
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
Lost Passport Number:
Issued on:
Issued by:
Date lost:

Lost due to:

Signature of Parent or Legal Guardian Signature of Applicant
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The supporting
documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am
allowed to hold only one Philippine passport at any given time. 6) I am aware that making false statements in passport application furnishing
falsified or forged documents in support thereof are punishable by law.
Signature of Applicant
REMARKS:
FOR STRICT COMPLIANCE: Please print name and affix initials.
Processor: Encoder: Signing Officer:
RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:
FOR ADMINISTRATIVE USE ONLY:
REPUBLIC OF THE PHILIPPINES
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

DATE OF BIRTH (Ex. Day/Month/Year)

FIRST NAME / PANGALAN (Jr. / II / III)

PLACE OF BIRTH / POOK NG KAPANGANAKAN

GENDER / KASARIAN
Civil Status: Single Married Widow/er Legally Separated Annulled
Name 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 of
Mother:
Citizenship:
Citizenship Acquired By:
Birth Election Marriage Naturalization
R.A.9225 Others: ________________________
Purpose of Travel:
Tour Seaman Business Migration
Study Work Others: ______________
Are you a holder of a foreign passport?
Yes No
If Yes, from what country? ___________________
Have you ever been issued a Philippine Passport?
Yes No
If Yes, latest passport number? _______________
Date of issue ________ Place of issue _________
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
Lost Passport Number:
Issued on:
Issued by:
Date lost:

Lost due to:

Signature of Parent or Legal Guardian Signature of Applicant
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The supporting
documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am
allowed to hold only one Philippine passport at any given time. 6) I am aware that making false statements in passport application furnishing
falsified or forged documents in support thereof are punishable by law.
Signature of Applicant
REMARKS:
FOR STRICT COMPLIANCE: Please print name and affix initials.
Processor: Encoder: Signing Officer:
RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:
FOR ADMINISTRATIVE USE ONLY:
REPUBLIC OF THE PHILIPPINES
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

DATE OF BIRTH (Ex. Day/Month/Year)

FIRST NAME / PANGALAN (Jr. / II / III)

PLACE OF BIRTH / POOK NG KAPANGANAKAN

GENDER / KASARIAN
Civil Status: Single Married Widow/er Legally Separated Annulled
Name 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 of
Mother:
Citizenship:
Citizenship Acquired By:
Birth Election Marriage Naturalization
R.A.9225 Others: ________________________
Purpose of Travel:
Tour Seaman Business Migration
Study Work Others: ______________
Are you a holder of a foreign passport?
Yes No
If Yes, from what country? ___________________
Have you ever been issued a Philippine Passport?
Yes No
If Yes, latest passport number? _______________
Date of issue ________ Place of issue _________
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
Lost Passport Number:
Issued on:
Issued by:
Date lost:

Lost due to:

Signature of Parent or Legal Guardian Signature of Applicant
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The supporting
documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am
allowed to hold only one Philippine passport at any given time. 6) I am aware that making false statements in passport application furnishing
falsified or forged documents in support thereof are punishable by law.
Signature of Applicant
REMARKS:
FOR STRICT COMPLIANCE: Please print name and affix initials.
Processor: Encoder: Signing Officer:
RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:
FOR ADMINISTRATIVE USE ONLY:
Thu, Dec 08, 2011 09:30 am
FRANCIS JONEL
LUGO
LO
MALE SEP 20, 1988
TACLOBAN CITY, LEYTE
FJL_30@YAHOO.COM
1652 GLADIOLA EXT. SARANAY HOMES, BAGUMBONG, NOVALICHES, CALOOCAN CITY, CALOOCAN CITY NA 9625645
09154030724 ACCOUNTANT
121 ARZOBISPO ST. INTRAMUROS MANILA
FRANCISCO ROMAQUIN LO, JR FILIPINO
GLORIA MIRASOL LUGO FILIPINO
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