en ocrsycuaunascent OPAS-TAS Republic of the Philippines DEPARTMENT OF FOREIGN AFFAIRS lomatic and Official Passport Section “Te. No. 8944060 lec 2292: Fax No, £96 7785: Emel dons€@yahoo.cem ph PASSPORT APPLICATION FORM "TAS APPLICATION FORMS NOT FOR SALE, PLEASE DO NOT LEAVE ANT SPACES BLA, INDICATE WA IF NOT APPLICABLE. PROVIDING FALSE STATEMENTS IN THE PASSPORT APPLICATION IS PUMSHABLE BY LAW (RA. 8229) [oe NAME FIRST NAME MIDDLE NAME PLACE OF BIRTH 7 GENDER: C1 MALE = CIFEMALE Meth Day Yer bare oF re | Ct Status: D singe Cl Maried Cl Widower) Legally Separated Di annuted Complete Adios: Tel Ne mat Adress: im Name of Spouse: Gites Name of Father: Citizenship: aiden'Single Name of ther zens: [citizenship Accuied By: Cb Ekcon Marriage] Natwraraion = JRA9225 Obs: [are youa Poker ofa freon passport?’ Ces} No ‘Have you evr boen issued a Pippine Passport? [Yes] No Yes, kom what country? UWYes, lest Passport Number? Date of sue Plage of issue, IPURPOSE OF TRAVEL = ae DATE OF TRAVEL lbestinarion ‘ Transit via Request for Note Verbale —ClYes. 1 No JOFFICE OF EMPLOYMENT : JbesiaNaTion Ca Stated inthe Senies Record TSOLEMNLY SWEAR UNDER PENALTY OF LAW that te statements made on tis application form are true and the attached documents are authentic. ‘Signature of Applicant Received Cancelled Passport Received New Passport ‘Signature over Printed Name/Date Signature over Printed Name/Date FOR USE OF THE DEPARTIENT OF FOREIGN AFFAIRS ONLY. REMARKS: Date Tine H Processor 2. Encoder 3 ‘Approving Oficor [Conformé, Signature over Pinted Name [Fasspor'Sieker SS