Republic of the Philippines Pi Form No. APPLICATION FOR POSTALID CARD | 22:5: ALLFIELDS WITH (~~) AREREQUIRED. foonrehesninceneirmteyasieaioct | oRN-— oka PART | -TO BE FILLED OUT BY THE APPLICANT ‘A. APPLICATION TYPE PURPOSE carvTyet | peuvery {RO REPLACEMENT vender Name Amendment Athentetng Finger Dona Desi Chrecotan | Cy pepcererteton crt Ci epncenent ot nagednd Dh aevena | Chercmuw | Cause Dl hrencmerte aprox Deter Exe ur ad POSTAL REFERENCE NO.(eavbinkitNew Apcatin] RAE (HRSTHAME) ~~ (ue kane (ustauey sure poiriiiy ER BREF NDOT PCE TOT ORICA 7 RCE [coon TREES E STAR ‘DOTA TASTE ory TREES HADEN STE ‘DBT TaST ca RITA IRCuRTaR ST Lsnge CD vones vide Ce lovecat Fisna TT enbeT THe Tenia Tava ae) Ne TTT PATER nee a Wa mee) aT TAT reowrceran [FEPFONE NUMBER TRENT STNG RAR ETRE, WERT TT NCR CRT EES ERAT ORES reas PREFERRED MAILING ADDRESS (roosove) Conse Cl wonx ed "ADDRESS yourusunirno./s.. name) [vous tor 4 ux0) sree wane ‘BORDON aNCRTHITRETTBALTY TaN CATT ROWING counrmry JPost ona Litt irene ‘ADDRESS (COMPRNTRNFLUUNTNO./BLD.KAME) [vous Lor uxN0) sree naney ‘BORDON TaaNeRTHITRETTBLTY TeTMOWERALTIT ROWING coon JPost ave Pit eke FINGERPRINTS IF APPLICANT CANNOT SIGN: sang the condenty ofthe data tat have sporti, Ihre ve ‘ther purpores content wit he obec fh cae erate the tm ht by ‘Sewue core and complete tthe best of my sbonlege ae belt Further whe peng RGHTTHONE TIGHT OER APPLICANT'S SIGNATURE WITNESS’ SIGNATURE SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME PART II -TO BE FILLED OUT BY PHLPOST SUPPORTING DOCUMENTS PRESENTED: "APPROVED BY Lnso pit censtene 1 tarnoaycoiete Totnes SIGNATURE OVER PAINTED NAME Dar DATA CAPTURE SCHEDULE DATACAPTORED BY ScHEENED BY ating a Ofce Name Cote SIGNATURE OVER PRINTED NAW DATE | dite Tne SIGNATURE OVER PRINTED NAME OnE TEAR HERE Republic of the Philippines T ppicaton entelNo PHLPOSTS. PHILIPPINE POSTAL CORPORATION | jv yc ouecase APPLICATION FOR POSTALID CARD) se". ACKNOWLEDGEMENT SLIP ( CLIENT COPY } Pi} iittitt APPROVED RY, ‘DATA CAPTURE SCHEDULE DATA CAPTURED tring as Ofc Name oe SIGNATURE OVER PAINTED NAME ATE daertine SIGNATURE OVER PRINTED NAME OnE For Inquiries, Please Call Customer Service Hotline 52754092 3. 5. 6. 7 10. 1. GENERAL TERMS AND CONDITIONS The Postal Identification Card (or Card) is issued exclusively by Philippine Postal Corporation (PHLPost) as proof of address and identity of the cardholder. The card is a property of the cardholder. The card is non-transferable. A unique Postal Reference Number (PRN) is assigned to each cardholder. The card is valid for three (3) years. The cardholder is responsible for the proper use of his/her card at all times and must keep the card secure. Alteration or intentionally damaging the card, using another person's card, or allowing the card to be used by another person is not allowed and it may result in confiscation and/or termination of the card as well as legal action(s) by government enforcement agencies and PHLPost, If card is lost, stolen or damaged, the cardholder must report it to the Postal Payment Services Division, Business Lines Department by mail, email and/or call within five (5) days: Malling address: The Postal Payment Services Division Business Lines Department 5/F Manila Central Post Office Bldg LiwasangBonifacio 1000 Manila City, Philippines Email ppsdiv.bld@phipost.gov.ph psdiv.bld.phipostagmail.com Telephone No: +6325275872 Fax No: +6325270151 8.1 The cardholder may request for replacement of the lost, stolen or damaged card. to any post office, subject to compliance to the requirements for replacement and payment of applicable fees and charges PHLPost is not responsible for any unauthorized use of the card or for any loss arising from the failure of the cardholder to comply with these terms and conditions. A list of documentary requirements for application of a Postal ID is available at all post offices and at the PHLPost website (www-phlpost.gov.ph). By applying for and/or using the card, the cardholder agrees to the terms of its issuance as governed by the PHLPost regulations. If the cardholder was found to have provided false information, falsified documents or has willingly applied for a Postal ID through fraudulent means, he/she may be subjected to legal sactions,