KONSULADO PANLAHAT NG PILIPINAS CONSULATE GENERAL OF THE PHILIPPINES
SHANGHAI NOT FOR SALE
PLEASE PRINT CLEARLY AND LEGIBLY AND PROVIDE CORRECT INFORMATION.
LAST NAME / APELYIDO FIRST NAME / PANGALAN (Jr./II/III)
____ ___________
MIDDLE NAME / GITNANG PANGALAN PLACE OF BIRTH /POOK NG KAPANGANAKAN
____ ___________
DATE OF BIRTH / PETSA NG KAPANGANAKAN
Day Month Year GENDER / KASARIAN: □MALE □FEMALE
/ ____/
(EX.01 JANUARY 2010)
(For Applicants)
Civil Status: □Single □Married □Widow/er □Legally Separated □Annulled
Name of Wife/Husband: _______________________Citizenship：
( First Name Middle Name Last Name )
Complete Address in China:____________________________________________________________________________
__________________________________________________________________________________________________
Present Occupation: ___________________Mobile No: _______
Name of the Company:_____________________________________________________
Company Address: _______________________
______________________________________________________________________________________
E-mail Address: ____________________Tel.No.: ______
Name of Father: ___________________ Citizenship: _____
(First Name Middle Name Last Name)
Maiden/Single Name of Mother: __________________Citizenship: _ ____
(First Name Middle Name Last Name)
□Citizenship Acquired By: Purpose of Traveler:□Tour□Seaman□Business□Migration
□Birth□Election□Marriage □Naturalization □study□work □Others
Are you a holder of a foreign passport? □Yes □No Have you ever been issued Philippine Passport? □Yes □No
If yes, from what country? If Yes, Latest Passport Number? _______
__________________________________________________ Date of lssue: ________
Place of lssue: ___________
This serves as Affidavit Of Support and Consent to Travel This serves as an Affidavit of Loss:
(for Applicants below 18 years old ONLY) Lost Passport No: ______lssued on: _________
Name of minor’s travelling companion: ________ lssued by: _________Date lost:
Companion’s Relationship: _____________________ Lost due to: _________________________
Address/Contact Number _________________________
Signature of Applicant
Signature of Parent or Legal Guardian
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 Iaw, I am allowed
to hold only one valid Philippine passport at any given time. 6) I am aware that making false statements in this passport application, furnishing
falsified or forged documents in support thereof, is punishable by law.
Signature of Applicant
REMARKS: FOR ADMINISTRATIVE USE ONLY
FOR STRICT COMPLIANCE: Please print name and affix initials.
Processor: Encoder:
Received Cancelled Passport: Fee: OR Number:
Received New Passport: Date: