STAMPED

Republic Act No. 1958

Form Harrasment Act of
2019
CEBU PACIFIC PLANE BOOKING
Form designed by Cat Republic

WARNING: This form is not officially approved by the Department of Transportaion and could not follow Republic Act No. 1958 or the Form Harrasment Act of 2019. Any
misbehaviours of this form is not the fault of the company but the form itself. Please download an official approved type of this form.
Please start registering using the form below. We will not accept register submissions after February 10,
2025.
Submit legibly. Tick appropriate boxes ( ) if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1.ID (Do not fill up. Staff users only.)
I. PERSONAL INFORMATION
2. LAST NAME

NAME EXTENSION (JR. SR.)

FIRST NAME

MIDDLE NAME

3. II. ADDRESS AND CONTACT

DATE OF BIRTH (MM/DD/YYYY)
9. COUNTRY NAME

4. PLACE OF BIRTH 10. PERMANENT

ADDRESS
House/Block/Lot No. Street
5. SEX
Male Female
Subdivision/Village Barangay
6. CIVIL STATUS
Single Married
Widowed Separate City/Municipality Province
d
Other/s:Please indicate if necessary. 11.
ZIP CODE
7. HEIGHT (m)

8. WEIGHT (kg) 12. MOBILE/TELEPHONE NUMBER

14 BLOOD TYPE 13. EMAIL ADDRESS

III. PASSPORT AND PLANE DETAILS

14. PLANE NAME 19. PASSPORT DETAILS
Name ID
15. PLANE TYPE 20. DESTINATION

16. PLANE ID (Do not fill up. Staff users only.) 21. ROUTE

17. AIRPORT 22. PILOT (Do not fill up. Staff users only.)

IV. ADDITIONAL INFORMATION

28. CITIZENSIP Dual
23. GSIS ID NO. by
Filipino
Citizenship
If holder of dual citizenship, ✘ by naturalization
24. PAG-IBIG ID NO.
please indicate the details.
bir
th
25. PHILHEALTH NO. If dual citizenship, indicate details below.
26. SSS NO.
27. TIN NO.

SIGNATURE DATE

PLEASE TAKE NOTE: After filling in the form, please pass a hard copy at a near airport or submitting a soft copy through Goggle Drive or
29. FORM NO.
social media.