Important Reminders

☐ Your appointment is on Wednesday, Jan 09, 2019 at 11:00 - 12:00.

Please be at Cagayan De Oro (Centrio Mall, Cagayan de Oro City) 15-
30 minutes before your scheduled appointment.
☐ Please make sure you have prepared all the requirements.
You may refer to https://consular.dfa.gov.ph/passport
Processing fee is non-refundable and non-transferrable.
☐ Be ready with both the original and photocopies of your documents during your
appointment. Application processing may be delayed if applicants are not ready
with copies of their documents once inside the data capturing site.

☐ For your NSO/PSA Certificate requirements, you may contact

https://www.ecensus.com.ph/

☐ Kindly print your duly accomplished application form (with barcode) and e-
receipt on A4-size paper. You must have a printed application form and e-receipt
to show and submit at your chosen application site.

Steps at the Data Capturing Site

Step Have your appointment verified at the verification section.
Present your duly accomplished application form, an ID, and your e-receipt.
1 Please double check that the verifier has signed or stamped your
form before proceeding to the next step.
Present your verified application form and requirements to the processor.
Please note that you MAY be required to present other requirements. Payment
Step of Processing Fee does not guarantee approval of your application. If
2 approved, double check that the processor has signed your form.
Once approved, proceed to the data capturing / encoding section.
Please remove all hair accessories, colored contact lenses, piercings
on the face and ears while waiting your turn.
Step When your photo has been captured and your information encoded,
3 please double check that all information entered is complete and correct.
At Consular Offices: You may opt in for courier services. Please
approach any of the couriers inside the capture site.
Passporting on Wheels: Courier services are mandatory.

Step
4

Reminders
Please wear clothing that will cover your shoulders. Avoid wearing strapless,
spaghetti-strapped, or tank tops; halters; backless; see-through or cut-out tops;
and deep necklines. Please do not wear shorts, shorts skirts. Please wear shoes.
Remember, you are entering a government office. Please dress appropriately.
You want to look good in your passport photo, but please do not put on heavy or theatrical make-up. This may result
with you having to remove your make-up during the photo.
APPOINTMENT Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015

DETAILS:
Cagayan De Oro (Centrio DEPARTMENT OF FOREIGN
AFFAIRS
Mall, Cagayan de Oro
City) PASSPORT APPLICATION FORM
Wednesday, Jan 09, 2019
THISAPPLICATION FORM IS NOT FOR SALE. PLEASEDO NOT LEAVEANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE.
PROVIDING FALSE
11:00 - 12:00

STATEMENTS IN PASSPORT APPLICATIONSIS PUNISHABLE BY

LAW(R.A. 8239).

CABARON ________________________ ROLINDA

LAST NAME/ FIRST NAME/ PANGALAN
APELYIDO (Jr./II/III)
YORO PHILIPPINES /VALENCIA, BUKIDNO…
MIDDLE NAME/ GITNANG PLACE OF BIRTH/ POOK NG
PANGALAN KAPANGANAKAN
NOVEMBER / 08 / 1973 GENDER/ □ MALE □ FEMALE
KASARIAN
Month Day
DATE OF BIRTH/ PETSA NG
Year
D
KAPANGANAKAN
(Ex.: March8, 2010)
Civil □ Single □ Married □ Widow/er □ Legally Separated □ Annulled
Status:
Complete Address: P-2 LUMBO, VALENCIA CITY, BUKIDNON, VALENCIA, BUKI NON Tel. No.:+639069336700
Present Occupation: HOUSEWIFE Mobile No.:+639069336700
Work Address: P-2 LUMBO, VALENCIA CITY, BUKIDNON Tel. No.:+639261617343
E-mail Address: KKOMON@Y HOO.COM
A
Name of Wife / Husband: EDWIN Z MB S C B RON Citizenship:PHL
Name of Father: ROGELIO B L GSO YORO Citizenship: PHL
Maiden/ Singlename of Mother: MIND FLOR RRIET BERRE Citizenship: PHL
Citizenship Acquired By:
P
□ Birth □ Election □ Marriage □ Naturalization □ R.A. 9225 □ Others _______________________
Are youa 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: __________
I

(For below 18 years old

applicants ONLY)
Name of minor’s travelling companion: ________________________________________________________________
Companion’srelationship: Contact Number: __________________________________

I SOLEMNLY SWE R 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 hilippine 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 Applicantor 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. ERWIN/ +639261617343 .

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

BELOWTHIS LINE.

REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer:

RECEIVED CANCELLED PASSPORT: RECEIVED NEWPASSPORT:
FOR ADMINISTRATIVE USE ONLY:
E-Receipt No: 1801200020 For moredetailsplease visit www.dfa.gov.phor
www.passport.gov.ph
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1801200020

PAYMENT DETAILS:
MERCHANT: ECPAY
71111461
BRANCH CODE:
REFERENCE NO: DFAVSE3UI2
DATE: 21-November-2018
TIME: 10:18:21 AM

APPOINTMENT NUMBER:
00152019010900007
NAME: ROLINDA CABARON
SITE NAME: CAGAYAN DE ORO (CENTRIO MALL, CAGAYAN DE ORO CITY)
Y

TRANSACTION: PASSPORT
PROCESSING
P
PROCESSING EXPRESS O
TYPE:
C

MODE OF PAYMENT: C SH
A

SERVICE NUMBER:
F 1801200020
D

AMOUNT (E-PASSPORT FEE) P 950.00

(EXPEDITE FEE) P 250.00
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1801200020

PAYMENT DETAILS:
MERCHANT: ECPAY
71111461
BRANCH CODE:
REFERENCE NO: DFAVSE3UI2
DATE: 21-November-2018
TIME: 10:18:21 AM

APPOINTMENT NUMBER: 00152019010900007

NAME: ROLINDA CABARON N A CSITE NAME: CAGAYAN DE ORO

(CENTRIO MALL, C GAYA DE TORO CITY)L TRANSACTION: PASSPORT PROCESSING P EX RESS I PROCESSING
P

TY E: O YCMODE OF P YMENT:
PASSPORT FEE) P 950.00(EXPEDITE FEE) P 250.00
P CASH SERVICEANUMBER:1801200020 AMOUNT(E-