REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FOREIGN AFFAIRS

______________________________
Post

APPLICATION FOR TRAVEL DOCUMENT

PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK

LAST NAME
MIDDLE NAME
FIRST NAME
DATE OF BIRTH
Day

Month

GENDER
Year

PLACE OF BIRTH
CIVIL STATUS

MALE

FEMALE

AGE
SINGLE

MARRIED

WIDOW/ER

OCCUPATION
2x2 PHOTO

DISTINGUISHING MARK, IF ANY:

FOUR (4) 2x2 PHOTOS REQUIRED

NAME OF SPOUSE, IF MARRIED

CITIZENSHIP

IF DIVORCED OR WIDOWED,
NAME OF PREVIOUS SPOUSE
NAME OF FATHER

CITIZENSHIP

MAIDEN
NAME OF MOTHER

CITIZENSHIP

U.S. ADDRESS

TELEPHONE NO.

PHILIPPINE ADDRESS
PHILIPPINE CITIZENSHIP ACQUIRED BY
BIRTH
NATURALIZATION
R.A. 9225 (DUAL CITIZENSHIP LAW)

HAVE YOU EVER BEEN ISSUED A PHILIPPINE PASSPORT

YES

NO

IF YES, LATEST PASSPORT NUMBER

DATE OF ISSUE

PLACE OF ISSUE

ELECTION
OTHERS
REASON FOR APPLYING A TRAVEL DOCUMENT
I SOLEMLY SWEAR that the attached photograph is mine, that the statements made on this application form are true and that the attached
supporting documents are authentic.

SIGNATURE OF APPLICANT

IMPORTANT: IF APPLICANT IS UNABLE TO APPLY IN PERSON, THIS FORM SHALL BE

NOTARIZED.

SUBSCRIBED AND SWORN to before me this _____ day of ___________________ ,

20 ____ in ___________________________________________.

NOTARY PUBLIC

SEAL OF NOTARY PUBLIC

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