NBI Online Application

1 of 1

http://clearance.nbi.gov.ph/printout?id=N2237852959&refno=E3P7D8U4

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE
NATIONAL BUREAU OF INVESTIGATION

NBI CLEARANCE APPLICATION FORM

REFERENCE NUMBER

Thursday, June 18, 2015 (AM)

Valid Until July 03, 2015
APPLICANT TYPE
NEW

1. ID PRESENTED
Vote r's ID, Passport

2. PURPOSE TYPE
LOCAL

3. PURPOSE APPLICATION
LOCAL EM PLOYM ENT

BASIC INFORM ATION

5. FAMILY NAME
NECESITO

6. HUSBAND FAMILY NAME (FOR MARRIED WOMAN ONLY)

7. GIVEN NAME
IM EE

8. MIDDLE NAME
VEGA

9. NICKNAME

10. OTHER NAME/ALSO KNOW AS

11. DATE OF BIRTH

07/02/1990

12. BIRTH PLACE

ANTIPOLO CITY RIZAL

13. CITIZENSHIP
FILIPINO

14. GENDER
FEM ALE

16. SPOUSE

17. BIRTH PLACE

15. CIVIL STATUS

SINGLE

18. PRESENT ADDRESS

BLK 58 LOT 4 PHASE 2 BAGONG NAYON 2 BRGY SAN ISIDRO ANTIPOLO CITY RIZAL
19. CONTACT NUMBER
09475926041

20. EMAIL ADDRESS

aymi_ne ce sito@yahoo.com

21. IDENTIFYING MARKS

M OLE IN THE CENTER OF
THE FOREHEAD

24. COMPLEXION
FAIR

25. RELIGION
ROM AN CATHOLIC

ADDITIONAL INFORM ATION

22. HEIGHT
152

23. WEIGHT
49

26. EDUCATIONAL ATTAINMENT

M ASTERAL

27. OCCUPATION
NONE

PARENTS INFORM ATION

28. NAME OF FATHER
VIRGILIO B NECESITO

29. FATHER BIRTH PLACE

M ALABON M ANILA

30. NAME OF MOTHER

CORAZON V NECESITO

31. MOTHER BIRTH PLACE

NABUA CAM ARINES SUR

I certify that I have read and understood all the questions set forth in this application and answ er I have furnished on this form are true and correct to the best acknow ledge and belief. I understand that any false or
misleading statement is FALSIFICATION PUNISHABLE UNDER ARTICLE 171 & 172 OR REVISED PENAL CODE

________________________________

________________________________

36. DATE

37. SIGNATURE

2015 All Rights Reserved

6/16/2015 7:05 PM