Important Reminders

! Your appointment is on Mon, Dec 13, 2010 at 03:00 pm.

Please be at DFA Aseana by 02:30 pm.

! Please make sure you have prepared all the requirements.

You can view the list at www.passport.com.ph

! Please make sure to photocopy all of your requirements.

Applicants without a complete set of photocopies will not be entertained.

! For your NSO certificate requirements, you may call (02) 737-1111.
Nationwide delivery within 3-4 days.

! You may have your passport delivered for extra convenience.

Please prepare extra P120 for the delivery fee.

! Please print this page and the application form on LONG BOND PAPER.
Applicants without the printed application form will not be allowed entry at the DFA

! For questions or concerns, you may email info@passport.com.ph.

Thank you for using the DFA Passport Appointment System.
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF FOREIGN AFFAIRS
MANILA
E-PASSPORT APPLICATION
Mon, Dec 13, 2010 03:00 pm
PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK

MACALINO ALBERT
LAST NAME / APELYIDO FIRST NAME / PANGALAN (Jr. / II / III)

DIONISIO TONDO MANILA

MIDDLE NAME / GITNANG PANGALAN PLACE OF BIRTH / POOK NG KAPANGANAKAN

APR 02, 1981 MALE

DATE OF BIRTH (Ex. Day/Month/Year) GENDER / KASARIAN
Civil Status: Ӂ
X Single Ӂ Married Ӂ Widow/er Ӂ Legally Separated Ӂ Annulled
Name of Wife / Husband: Citizenship:
Complete Address: Tel. No:
Present Occupation: Mobile No: 09207782739
Work Address:
Email Address: AJBOYMACALINO@YAHOO.COM Office No:
Name of Father: JUANDEDIOS CARPIO MACALINO Citizenship:
Maiden/Single Name of
GIRLIE BANTIGUE DIONISIO Citizenship:
Mother:

Citizenship Acquired By: Purpose of Travel:

Ӂ Birth Ӂ Election Ӂ Marriage Ӂ Naturalization Ӂ Tour Ӂ Seaman Ӂ Business Ӂ Migration
Ӂ R.A.9225 Ӂ Others: ________________________ Ӂ Study Ӂ Work Ӂ Others: ______________

Are you a holder of a foreign passport? Have you ever been issued a Philippine Passport?
Ӂ Yes Ӂ No Ӂ Yes ӁX No
If Yes, from what country? ___________________ If Yes, latest passport number? _______________

Date of issue ________ Place of issue _________

This serves as Affidavit of Support and Consent to Travel This serves as Affidavit of Loss
(for Applicants below 18 years old ONLY) Lost Passport Number:
Name of minor's Issued on:
traveling companion:
Issued by:
Companion's
Relationship: Date lost:
Address / Contact Lost due to:
Number:

Signature of Parent or Legal Guardian Signature of Applicant

I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The supporting
documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am
allowed to hold only one Philippine passport at any given time. 6) I am aware that making false statements in passport application furnishing
falsified or forged documents in support thereof are punishable by law.

Signature of Applicant
REMARKS:

FOR STRICT COMPLIANCE: Please print name and affix initials.

Processor: Encoder: Signing Officer:

RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:

FOR ADMINISTRATIVE USE ONLY: