Important Reminders

Your appointment is on Wednesday, Dec 14, 2016 at 12:00 - 13:00.

Please be at NCR East (Megamall) at least thirty (30) minutes before your
scheduled appointment.

Please make sure you have prepared all the requirements.

Be ready with both the original and photocopies of your documents when you
appear for personal appearance. Application processing may be delayed if
applicants are not ready with copies of their documents once inside the data
capturing site.
For your NSO certificate requirements, you may call (02) 737-1111. Nationwide
delivery within 3-4 days.

Kindly print your application form (with barcode) in A4-size paper.

You must have a printed application form to show and submit at your chosen
application site.

Republic of the Philippines

APPOINTMENT DETAILS:

NCR East (Megamall)

Wednesday, Dec 14, 2016
12:00 - 13:00

WCS-RRR-LVJZ-PPT-DORev. October2015

DEPARTMENT OF FOREIGN AFFAIRS

PASSPORT APPLICATION FORM

THISAPPLICATIONFORMIS NOT FORSALE. PLEASEDONOT LEAVEANY SPACES BLANK, INDICATE N/AIF NOT APPLICABLE. PROVIDINGFALSE
STATEMENTS INPASSPORT APPLICATIONSIS PUNISHABLE BY LAW(R.A. 8239).

_______________________________________
PAGATPATAN

___________________________________________
LINDA

LAST NAME/ APELYIDO

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

____________________________________________
ANDRES

________________________________________________
PHILIPPINES
/MONCADA, TARLAC

MIDDLE NAME/ GITNANG PANGALAN

PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
/ __________
JULY
11 / ___________
1954
Month
Day
Year
DATE OF BIRTH/ PETSA NG KAPANGANAKAN
(Ex.: March8, 2010)

GENDER/ KASARIAN

Civil Status:

Single

Married

Widow/er

MALE

Legally Separated

FEMALE

Annulled

11, LOT 42, PHASE 1, AFP EP HOUSING, PINAGSAMA, TAGUI Tel. No.:____________________
+6328384165
Complete Address: BLOCK
________________________________________________________
+639997412049
Present Occupation:HOUSEKEEPER
_______________________________________________________ Mobile No.:_________________
NOT APPLICABLE
+6328384165
Work Address: ____________________________________________________________
Tel. No.:____________________
E-mail Address: LINDA.PAGATPATAN@YAHOO.COM
_______________________________________________________________________________________
FLORA PAGATPATAN
Name of Wife / Husband: REYNO
____________________________________________________
Citizenship:PHL
_________________
ANDRES
Name of Father: FLORENTINO
___________________________________________________________
Citizenship:PHL
_________________
SIBAYAN PALAFOX
Maiden/ Single name of Mother:SOFIA
______________________________________________
Citizenship:PHL
_________________

Citizenship Acquired By:

Birth Election Marriage Naturalization R.A. 9225 Others _______________________
Are you a holder of a foreign passport? Yes No Have you ever been issued a Philippine Passport? Yes No
If Yes, from what country?___________________
If Yes, latest Passport Number? _______________________
Date of issue: _________________ Place of issue: __________
(For applicants below 18 years old ONLY)
Name of minors travelling companion: ________________________________________________________________
Companions relationship: _________________________ Contact Number: __________________________________
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application are true and
correct. 3) The supporting documents attached are authentic. 4) I am aware that under the law, I am allowed to hold only one
Philippine passport at any given time. 5) 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 or Legal Guardian (for minor applicants)

ORGAN DONATION (Optional)

In case of death, I hereby donate [ ] Any organ / tissue [x ] Specific organ N/A
____________________ to save other people.
Please immediately notify my family at mobile / tel. no. OCTAVIO
___________________________.
T AQUINO/ +639997412

FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRSONLY. PLEASE DO NOT WRITE BELOWTHIS LINE.

REMARKS:

Processor:

RECEIVEDCANCELLED PASSPORT:

Encoder:

Signing Officer:

Transmission Officer:

RECEIVEDNEWPASSPORT:

FOR ADMINISTRATIVE USE ONLY:

For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph

REQUIREMENTS FOR FIRST TIME PASSPORT APPLICANTS

Confirmed appointment Duly accomplished application form may be downloaded from the
Additional Requirements
For married women:
DFA website, www.dfa.gov.ph
Marriage Contract (MC) in Security Paper issued by PSA or original and photocopy of the Certified True Copy of MC
Birth Certificate (BC) in Security Paper (SECPA) issued by the Philippine Statistics Authority (PSA) or Certified True Copy
issued by the Local Civil Registrar and duly authenticated by PSA. Transcribed MC from the LCR is required when
(CTC) of BC issued by the Local Civil Registrar (LCR) duly authenticated by PSA. Transcribed BC from the LCR is required when
entries in PSA MC are blurred or unreadable. Report of Marriage duly authenticated by PSA is required if married
entries in PSA BC are blurred or unreadable. Report of Birth duly authenticated by PSA is required if born abroad.
abroad. Original and photocopy of Commission of Filipinos Overseas (CFO) Guidance and Counseling Certificate of
One (1) pictured ID and two (2) supporting documents to prove identity if necessary (Please refer to list of Acceptable IDs
Attendance (required for women with foreign national husband).
and Supporting Documents)
In Case of No Birth Record:
Applicants who availed of Dual Citizenship under RA 9225
If born in or after 1950 (January 1, 1950 or after):
Apply for the delayed registration of birth at the local civil registry office located at the place of birth of applicant
Identification Certificate from the Bureau of Immigration
Submit authenticated Birth Certificate from PSA and supporting public document/s upon the discretion of the processor or
Oath of Allegiance
Consular Officer, with correct date and place of birth (i.e. Form 137, Voters Registration Record, Baptismal Certificate with readable
Order of Approval
dry seal or NCMF Certificate with photo and readable dry seal, for Muslim applicants)
Aliens who have elected Filipino citizenship
If born before 1950 and below (December 31, 1949 and below):
Identification Certificate from the Bureau of Immigration
Certificate of Non-availability of Birth Record from PSA
Oath of Allegiance
Notarized Joint Birth Affidavit of Two Disinterested Persons
Affidavit of Election of Philippine Citizenship
Any public document with correct full name, date and place of birth (i.e. Baptismal Certificate with readable dry seal or NCMF
Aliens who has been naturalized
Certificate with photo and readable dry seal, for Muslim applicants)
Identification Certificate from the Bureau of Immigration
Oath of Allegiance
For Minor Applicants (below 18 years old)
Confirmed appointment (except for 1 year old and below)
Original Birth Certificate (BC) of minor in Security Paper issued by PSA or Certified True Copy of BC issued by the
Personal appearance of the minor applicant
LCR duly authenticated by PSA. Transcribed BC from the LCR is required when entries in PSA BC are blurred or
unreadable. Report of Birth duly authenticated by PSA is required if minor was born abroad.
Personal appearance of either parent, PSA Marriage Contract, and valid passport of parents (if minor is a legitimate child) /
Document of identity with photo, if minor is 8-17 years old (for first time & renewal applicant) such as School I.D. or
Personal appearance of mother and proper ID or valid passport of mother (if minor is an illegitimate child)
Form 137 with readable dry seal. For minor applicants who never attended school, a Notarized Affidavit of Explanation
Original and photocopy of valid passport of the person traveling with the minor
executed by either parent (if minor is a legitimate child) / by mother (if minor is an illegitimate child) detailing the
reasons why the child is not in school, is required
Additional Requirements
Foundling:
If minor is not traveling with either parent or alone:
Certificate of foundling authenticated by PSA
P erson al appearance of either parent (if m inor is a legitim ate child) / of m other (if m inor is an illegitim ate child)
DSWD Clearance
Affidavit of Support and Consent (ASC) executed by either parent indicating the name of the traveling companion and
Passport of the person who found the applicant
relationship to the minor. If minor will be traveling alone, ASC must be executed by either parent, stating that his/her child will be
Letter of authority or endorsement from DSWD for the issuance of passport
traveling alone. If minor is illegitimate, mother should execute the ASC.
Legally adopted:
Original and photocopy of DSWD Clearance. There is no need to secure a DSWD Clearance if the minor traveling abroad has
Original and Certified True Copy (CTC) of the PSA amended Birth Certificate after adoption
parents who are in the Foreign Service or living abroad or are immigrants, provided he / she is holding a valid pass such as a
Certified True Copy (CTC) of the Court Decision or Order on Adoption and Certificate of Finality
dependents visa / pass / identification card or permanent resident visa / pass / identification card which serves as proof that he
DSWD clearance for minor applicant, if traveling with the person other than the adopting parents
/ she is living with parents abroad.
In case the applicant is for adoption by foreign parents:
If both parents are abroad:
Certified True Copy of the Court Decree of Abandonment of Child
Affidavit of Support and Consent (ASC) executed by either parent indicating the name of the traveling companion (authenticated
PSA Death Certificate of the childs parents or the Deed of Voluntary Commitment executed after the birth of the child
by the nearest Philippine Embassy or Consulate General). If minor is illegitimate, mother should execute the ASC.
Endorsement of child to the Inter-country Adoption Board by the DSWD
Special Power of Attorney (SPA) with an attached photocopy of either parents valid passport (authenticated by the nearest
Authenticated Birth or Foundling Certificate
Philippine Embassy or Consulate General) authorizing a representative in assisting the child to apply for a passport. If minor is
Minor applicant whose parents are annulled / divorced:
illegitimate, mother should execute the SPA.
Court order awarding guardianship of the minor applicant or substitute parental authority
Original and photocopy of DSWD Clearance. There is no need to secure a DSWD Clearance if the minor traveling abroad has
DSWD Travel Clearance
parents who are in the Foreign Service or living abroad or are immigrants, provided he / she is holding a valid pass such as a
PSA Marriage Certificate with annotation on nullity or annulment decree
dependents visa / pass / identification card or permanent resident visa / pass / identification card which serves as proof that he
Minor applicant whose mother is likewise a minor:
/ she is living with parents abroad.
Personal appearance of mother and maternal grandparent/s
Proper ID of the duly authorized representative (Please refer to List of Acceptable IDs)
PSA Birth Certificate of minor applicant and mother
If minor is legitimated by subsequent marriage of parents:
Affidavit of Support and Consent executed by the maternal grandparent/s indicating the name of the traveling
Authenticated Birth Certificate from PSA with annotation regarding new status as legitimated and the full name of the child
companion
If minor is illegitimate but acknowledged by father:
DSWD Clearance if minor will be traveling with the person other than the maternal grandparent/s
Birth certificate from PSA reflecting surname of father with Affidavit of Acknowledgement and Consent to use surname of father
Proof of identity of mother and maternal grandparent/s (Please refer to List of Acceptable IDs)
Orphaned minor applicant:
Authenticated Death Certificates of parents from PSA
For Muslim applicants (same general requirements stated above)
Court order awarding guardianship of the orphaned minor applicant or substitute parental authority under Article 214 & 216 of
For late registered Muslim applicants:
the Family Code
Certificate of Tribal Affiliation from the National Commission on Muslim Filipinos (NCMF)
DSWD Clearance
Abandoned minor applicant:
For converts who would like to use their Muslim name:
Court order awarding guardianship of the abandoned minor applicant or substitute parental authority
Annotated Birth Certificate (BC) in Security Paper (SECPA) issued by PSA bearing the Muslim name
DSWD Travel Clearance
NCMF Certificate of Conversion
REQUIREMENTS FOR RENEWAL OF PASSPORT
Personal appearance
Confirmed Appointment
Duly accomplished application form may be downloaded from the DFA website, www.dfa.gov.ph
Most recent passport (expiring or expired)
One (1) pictured ID and two (2) supporting documents to prove identity if necessary (Please refer to List of Acceptable IDs and Supporting Documents)
Brown Passport or passports issued prior to 01 May 1995:
Machine Readable Passport (MRP) issued in the year 2007:
Bring original brown passport and photocopy of passport pages 1,2,3,4 and last page
Bring original passport and photocopy of first and last page of passport
Birth Certificate in Security Paper issued by PSA or Certified True Copy of BC issued by the Local Civil Registrar duly
Birth Certificate (BC) in Security Paper (SECPA) issued by the Philippine Statistics Authority (PSA) or Certified
authenticated by PSA, to determine complete middle name. Transcribed Birth Certificate from the LCR is required when entries in
True Copy (CTC) of BC issued by the Local Civil Registrar (LCR) to determine complete place of birth. Transcribed Birth
PSA Birth Certificate are blurred or unreadable. Report of Birth duly authenticated by PSA if born abroad
Certificate from the LCR is required when entries in PSA Birth Certificate are blurred or unreadable
Green Passport or passports issued after 01 May 1995:
Electronic Passport (E-passport)
Bring original green passport and photocopy of the data page and last page of passport
Bring original e-passport and photocopy of page 2 (data page) of passport
For women who would change their civil status from single to married:
For minor applicants, requirements for first time minor applicants are still
Marriage Contract (MC) in Security Paper issued by PSA or Certified True Copy of MC issued by the Local Civil Registrar and
prescribed, in addition to the passport of minor.
duly authenticated by PSA. Transcribed Marriage Contract from the LCR is required when entries in PSA Marriage Contract are
blurred or unreadable. Report of Marriage duly authenticated by PSA if married abroad
For spouse of foreign national who would change their civil status from single to married:
For Muslim Applicants (same general requirements stated above)
Marriage Contract (MC) in Security Paper issued by PSA or Certified True Copy of MC issued by the Local Civil Registrar and
For converts who would like to use their Muslim name:
duly authenticated by PSA. Transcribed Marriage Contract from the LCR is required when entries in PSA Marriage Contract are
Annotated Birth Certificate (BC) in Security Paper (SECPA) issued by PSA bearing the Muslim name
blurred or unreadable. Report of Marriage duly authenticated by PSA if married abroad
National Commission on Muslim Filipinos (NCMF) Certificate of Conversion
Original and photocopy of Commission of Filipino Overseas (CFO) Guidance and Counseling Certificate of Attendance
For married women who would like to revert to their maiden name:
For naturalized Filipinos or applicants that elected Philippine Citizenship and holder of brown or green
Birth Certificate (BC) in Security Paper (SECPA) issued by PSA or Certified True Copy of BC issued by the Local Civil Registrar
passport
Bureau of Immigration Identification Certificate
and duly authenticated by PSA. Transcribed Birth Certificate from the LCR is required when entries in PSA Birth Certificate are
Certificate of Naturalization
blurred or unreadable. Report of Birth duly authenticated by PSA is required if born abroad
Election of Filipino Citizenship / Oath of Allegiance
If already widowed: Death Certificate in Security Paper (SECPA) issued by PSA of the deceased husband
If marriage is annulled: Certified True Copy of annotated PSA Marriage Contract and Court Order effecting the annulment.
Applicants who re-acquired Filipino Citizenship
If divorced: Certified True Copy of the Divorce Decree duly authenticated by the Philippine Embassy or Consulate where the
Identification Certificate
divorce was obtained or by the concerned foreign diplomatic or consular mission in the Philippines. Original and CTC of Phil.
Oath of Allegiance
Court recognition of foreign divorce decree must also be present and the PSA MC with the annotation of the Divorce Decree.
Order of Approval
Report of Birth (for those born abroad)
REQUIREMENTS FOR REPLACEMENT OF LOST PASSPORTS
LIST OF ACCEPTABLE IDS (At least 1 of the following):
Personal appearance
Government-issued IDs such as digitized SSS ID, Drivers License, GSIS E-card, PRC ID, IBP ID, UMID, Voters ID, and
Confirmed Appointment for applicants with expired passports and issued travel documents (lost-valid passport
Senior Citizens ID
applicants may proceed directly to the Consular Records Division at DFA-Aseana without an appointment)
Other acceptable picture IDs include old College ID, Alumni ID, or old Employment IDs
Duly accomplished application form may be downloaded from the DFA website, www.dfa.gov.ph
Requirements for the first time applicants is still prescribed
LIST OF SUPPORTING DOCUMENTS (Old documents issued at least one year prior to date of application that
show correct name, date and place of birth, picture, and signature of applicant, at least 2 of the following):
In case passport was lost and cannot be found:
Submit Notarized Affidavit of Loss (with detailed explanation on when, where and how passport got lost).
PSA Marriage Contract
If the lost passport is still valid, submit Police Report.
Land Title
Photocopy of first page of lost passport (if available)
Seamans Book
There will be a 15-day clearing period prior to the processing of application for replacement of a lost valid passport
Elementary or High School Form 137 or Transcript of Records with readable dry seal
In case passport was already declared lost by the applicant but eventually was found and returned to him/her:
Government Service Record
Notarized Affidavit of Retrieval (with detailed explanation on when, where and how passport was found)
NBI Clearance
Original and photocopy of first and last page of passport
Police Clearance
In case of mutilated or damaged passports:
Barangay Clearance
Notarized Affidavit of Mutilation (with detailed explanation on when, where and how passport got mutilated or damaged)
Readable SSS-E1 Form or Microfilmed copy of SSS-E1 Form
Original and photocopy of first and last page of mutilated or damaged passport
Voters Certification, List of Voters and Voters Registration Record (for newly issued VRR, please attach receipt)
In case applicant was issued a Travel Document:
School Yearbook
Original Travel Document
Digitized Postal ID
Notarized Affidavit of Explanation Regarding Issuance of Travel Document (with detailed explanation on when, where and
why applicant was issued a travel document)
Original and photocopy of first and last page of cancelled passport (if passport is still in the possession of the applicant)
There will be a 15-day clearing period prior to the processing of application for replacement of a lost valid passport
REMINDERS
Passport shall be released to an immediate family member only with proper authorization letter and proof of
identity. Immediate family members include father, mother, brother, sister, spouse and children of legal age.
Personal appearance is required for all applicants
Passport of a minor applicant shall be released to parents only or to an authorized representative with Special
Confirmed appointment is required for all applicants except senior citizens, infants & minors below 1 year old and OFWs. For
Power of Attorney & Affidavit of Support and Consent.
OFWs, sufficient proof must be submitted such as valid employment contract or OEC.
Passports unclaimed after 6 months will be cancelled per Department Order No. 37-03.
Earrings & contact lenses are not allowed during data capturing. Smiling with visible teeth is also not allowed.
Check all data in the received e-passport upon release.
Check all data in the computer monitor & in the Enrolment Certificate before signing.
Personal appearance

PASSPORT FEES:
Regular Processing (15 working days) : P950.00
Expedited Processing (07 working days): P1,200.00
For Replacement of a lost valid passport: Additional fee of P200.00 for a lost valid MRRP/MRP or P350.00 for a lost valid epassport
n Processing schedule may be changed upon prior notice
n Number of processing days may vary depending on the location of the Regional Consular Office where
the application was filed

Apply for your passport early, prepare requirements before appointment date, non-OFW and Metro Manilabased applicants should secure an appointment when applying for a passport, those in provinces can apply at
the nearest Regional Consular Office or during Mobile Passport Service (MPS), OFWs can apply at the DFA
Satellite Office located at Robinsons Galleria in Ortigas, Quezon City. Do not deal with fixers, avail of the
passport delivery service & take good care of your passport. For comments, complaints & assistance, please
contact the Public Assistance Center or the Passport Directors Office.

REQUIREMENTS ARE BASED FROM R.A.8239 OR THE PHILIPPINE PASSPORT ACT OF 1996 AND ITS IMPLEMENTING RULES AND REGULATIONS.