BINIBINING PILIPINAS CHARITIES, INC.

2012
BINIBINING PILIPINAS BEAUTY PAGEANT

OFFICIAL APPLICATION FORM

(Please fill out the form in your own handwriting and submit to the Bb. Pilipinas Secretariat)

BINIBINING PILIPINAS CHARITIES, INC. (BPCI) NEITHER COLLECTS, NOR HAS IT

AUTHORIZED ANY PERSON/ENTITY TO COLLECT ANY FEE IN CONNECTION
WITH THIS APPLICATION.

I. PERSONAL INFORMATION

NAME NICKNAME
PEN NAME, STAGE NAME, PSUEDONYM SEX

PRESENT ADDRESS HOUSE UNIT NO, STREET:

BARANGAY, CITY, PROVINCE
(If more than one address within the last five (5) years, including foreign addresses, kindly indicate the
same below, as well as length of stay and inclusive dates. Attach a separate sheet if necessary)
ADDRESS LENGTH OF STAY INCLUSIVE DATES

1.

2.

3.

CONTACT DETAILS
LANDLINE: CELLPHONE: EMAIL:
I can most easily be reached/contacted through:

AGE
PLACE OF BIRTH: DATE OF BIRTH:

CITIZENSHIP
a. Citizenship In Any Country and Details Thereof:
NATURAL/NATURALIZED
COUNTRY CURRENT STATUS
(If naturalized, date of naturalization)

b. Petitioned as Resident or Application for Residency in any Other Country and Details Thereof:
NATURAL/NATURALIZED
COUNTRY CURRENT STATUS
(If naturalized, date of naturalization)

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c. Status as Immigrant to any Other Country and Details Thereof:
DATE OF APPLICATION
COUNTRY CURRENT STATUS
(If naturalized, date of naturalization)

d. Application for Naturalization in any other Country and Details Thereof:

COUNTRY DATE OF APPLICATION CURRENT STATUS

PASSPORT DETAILS
Place Issued: Date Issued: Valid until:
Details of Foreign Passport or any other Foreign Travel Document (if any):

OCCUPATION
a. Details of Present Occupation
OCCUPATION EMPLOYMENT ADDRESS CONTACT NO.

b. Details of Prior Occupation

OCCUPATION EMPLOYMENT ADDRESS CONTACT NO.

c. Details of all OUSTANDING Contracts, Talent Management and Similar Agreements,

Sponsorships, Endorsements and the like, whether Written or Oral, with Whom Entered Into
and the Length of Effectivity thereof (attach Additional Sheets if necessary).
CONTRACT DESCRIPTION WITH WHOM LENGTH OF EFFECTIVITY

d. Details of all PAST Contracts, Talent Management and Similar Agreements, Sponsorships,
Endorsements and the like, whether Written or Oral, with Whom Entered Into and the Length
of Effectivity thereof (attach Additional Sheets if necessary).
CONTRACT DESCRIPTION WITH WHOM LENGTH OF EFFECTIVITY

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e. I Have Appeared and/or Currently Appear in the Following TV Show(s), Movie(s) and/or
Pictorial(s) (attach Additional Sheets if necessary).
MEDIA (TV Show, Movie, Pictorial) ROLE INCLUSIVE DATES

NOTE: For items (c), (d) and (e) of OCCUPATION, the APPLICANT is REQUIRED to DISCLOSE ALL
PRESENT and PAST Contracts, Talent Management and Similar Agreements, Sponsorships,
Endorsements and the like, including Fashion Shows and/or Print and Video Modeling Jobs and
PROVIDE BPCI with copies of Media the Applicant has appeared in.

PARTICIPATION IN OTHER BEAUTY PAGEANTS

BEAUTY CONTEST/ORGANIZER TITLE WON DATE

EDUCATION
SCHOOL/UNIVERSITY ADDRESS DEGREE/LEVEL YEAR GRADUATED

HIGHEST EDUCATIONAL ATTAINMENT:

LANGUAGES/DIALECTS SPOKEN:

OTHER PERSONAL INFORMATION

HOBBIES

SPORTS ACTIVITIES

TALENTS/SKILLS

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 FAMILY BACKGROUND
CONTACT
NAME OCCUPATION ADDRESS NOS.

FATHER

MOTHER

GUARDIAN
(if any)
If Parents are separated, who has legal custody (if Applicant is a minor):

Is the Parents’ separation legally documented? YES NO

NOTE: If Parents’ separation is legally documented, please provide VALID ORDER of CUSTODY.

BODY MEASUREMENTS AND INFORMATION

HEIGHT WEIGHT HAIR COLOR EYE COLOR
BUST WAIST HIPS

PERSONAL REFERENCES
(Provide At Least 3 References who are NOT Relatives)
NAME ADDRESS CONTACT NOS.

1.

2.

3.

4.

Reason/s for Applying for the 2012 Binibining Pilipinas Beauty Pageant (the “2012 Pageant”):

Other Interesting Personal Information (if any):

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II. CERTIFICATION AND WARRANTY OF INFORMATION/STATEMENTS

1. I certify that all of the following information/data and/or matters indicated in this Application Form
and such documents attached hereto are true, and that there are no false statements,
misrepresentations or omissions herein. Any such false statements, misrepresentations or
omissions will be sufficient ground for BPCI to reject this application, without prejudice to any
other legal remedies BPCI may be entitled to under the premises.

2. I further certify that:

a. I am neither married, nor have I ever been married; I have never sought the annulment of my
marriage or the declaration of nullity thereof, and that I have never been, nor am I presently
pregnant. I have neither given birth to child nor am I a parent;

b. I am in good mental, psychological and physical health, and that I have never been sick or
have been hospitalized for Cancer, Epilepsy, HIV, AIDS, heart ailment, a disease involving
the gastrointestinal system or any other disease that will impair my mental, psychological
and/or physical health or condition;

c. I am neither suffering from, nor have I ever been under prolonged medication for any
physical, neurological, psychological or psychiatric condition, including eating and/or
personality disorders which will impair my ability to act as an Applicant and/or Candidate of
the 2012 Pageant;

d. I am of good moral character;

e. I have never participated in any bold/burlesque shows, plays, movies, publications or

activities, or such show, play, movie, publication or activity, which, in the sole opinion and
discretion of BPCI, is inconsistent with my application with the 2012 Pageant, run counter
against the social and moral principles upon which the Pageant is founded upon, and/or bring
disrepute or embarrassment to BPCI or any of its sponsors;

f. I have not engaged in prostitution or any such act which can be deemed as similar or related
thereto;

g. I am neither a party to any existing Contract, which would, in the sole opinion and discretion
of BPCI, shall cause my disqualification as an Applicant to, or a Candidate of, the 2012
Pageant.

h. I was born with the anatomy of a female and that I have not consented to and/or underwent
any surgical, medical and/or cosmetic procedure to transform me into a biological female.

III. DOCUMENTS TO BE SUBMITTED

1. Attached to this Application Form is/are ____ copy(ies) of the following documents, the original of
which I am presenting to the BPCI Corporate Secretariat for comparison and verification:

a. CITIZENSHIP: (Please check applicable Citizenship category)

Natural-Born Citizen Balikbayan Who Re-Acquired Natural-Bon Citizen

Born In the Philippines
i. Birth Certificate; and
ii. Philippine Passport, if
applicable
Philippine Citizenship Born Outside the Philippines
Under R.A. 9225
i. Birth Certificate or
Report of Birth; and
ii. Identification certificate
issued by the Bureau of
Immigration
i. Report of Birth issued
by the Philippine
Consulate in the
country of Birth; or
ii. NSO certificate stating
that birth was reported
by the Philippine
consulate and
recorded in the
PHilippines

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 b. RESIDENCE: (Please check applicable Residence category)

Has NOT Resided Outside the Has Resided Outside the

Philippines Philippines
i. Valid ID Showing i. Valid ID showing Philippine
Philippine Address Address; and
ii. Any of the following:
a. Philippine Passport;
b. Foreign Passport; or
c. Certificate from Bureau
of Immigration stating
date of entry into the
Philippines

c. High School or College Diploma;

d. Medical Certificate for both my Physical and Mental health and well-being; and

e. Certificate of Good Moral Character given by my School, Church or Professional

Organization.

2. In addition to the documents listed above, I also submit two (2) photographs, one close-up and
one full body shot.

(To be accomplished by BPCI)

Received: Close Up Photo

Received: Full Body Shot Photo

3. I hereby authorize BPCI to verify the truth of all my assertions herein and the genuineness/validity
of all the documents I have submitted, thereby waving for these purposes the provisions of all
laws, rules and regulations, local or foreign, relating to the privacy or confidentiality of the matters
hereunder.

4. I warrant that the documents I have submitted are public documents in my possession or which
came into my possession legally and/or are public documents attested to by the officer/s having
the legal custody of the records, and that, where applicable, the entries therein were made in the
regular performance of an official duty, and that I will hold BPCI free and harmless from a breach
of this Warranty.

IV. UNDERSTANDING OF CONDITIONS

1. I understand that I am applying as a candidate of the 2012 Pageant and that the requirements
and/or limitations with regard to age, residency, and citizenship may vary, subject to the
requirements of different international pageants, and accordingly, that my qualifications are
further subject thereto.

2. I am aware that BPCI, at its sole discretion, may require me to submit additional and sufficient
proof of age, residency, citizenship, health and other documentation/information regarding my
qualifications. Should I be required to do so, I undertake to provide BPCI with such requested
documentation information, and failing to comply within the period to submit, as determined by
BPCI, I understand that my application will not be considered complete and submitted.

3. I understand that I have to pass the screening and meet all the requirements of BPCI and the
qualifications of the different international pageants before I can qualify as a candidate of the
2012 Pageant. I further understand that the basic requirements relate to information obtained
from me as contained in this Application Form

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 4. In considering my application to be a candidate of the 2012 Pageant, I also understand that
personal achievements, intelligence, beauty, physical fitness, personal style and charisma,
among other criteria, shall also be considered. I agree that all issues as to my eligibility as an
applicant shall be determined solely by BPCI and that I shall abide by its determination, which
shall be final and non-appealable.

5. In filling out and signing this Application Form, I further understand that BPCI is under no
obligation to accept me as a candidate. My acceptance as an official candidate shall commence
only when I am formally and specifically notified thereof.

6. If I am chosen as an official candidate, this Application Form shall be considered part and parcel
of the Official Entry Form/Contract which I shall be required to sign.

7. I understand that in signing this Application Form, I have accepted the sole discretion of BPCI to
accept or reject me as a candidate of the 2012 Pageant and that the decision of BPCI on this
application is final and non-appealable.

8. I finally certify that I have read this Application Form carefully, that I have understood the same,
and that no promises or representations were made to induce me to sign this Application Form.

APPLICANT
(Signature Over Printed Name)

Signature/s above printed names of both Parent/s (Custodial Parent if Separated or if parent is
Solo Parent) or of Legal Guardian, if applicant is a minor:)

FATHER

MOTHER

LEGAL GUARDIAN

Date:

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