DFA-OCA-DOPS-02
Republic of the Philippines REV. 01 / 24 OCT 2018
DEPARTMENT OF FOREIGN AFFAIRS
Diplomatic and Official Passports Section
Tel. N o. 651-94 19; Fax No. 836 -7765; e -mail [Link]@[Link]
PASSPORT APPLICATION FORM
THIS APPLICATION FORM IS NOT FOR SALE. PLEASE DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICA
BLE. PROVIDING FALSE STATEMENT IN THE
PASSPORT APPLICATION FORM IS PUNISHABLE BY LAW (R.A. 8239)
LAST NAME FIRST NAME (Jr., Sr., II, III)
_________DEBELEN_________________ __________JOANNE______________________
_ _
MIDDLE NAME PLACE OF BIRTH
_______MEDINA______________________ __PASONG BANGKAL SAN ILDEFONSO,
BULACAN_______________
DATE OF BIRTH (DD / MONTH IN GENDER
WORDS /YYYY)
__14____ / _____APRIL________ _2002__ √
/ _________ MALE FEMALE
Civil Status: √ Single Married Widow/er Legally Sepa rated
Annulled
Complete Address: ____PASONG BANGKAL
SAN ILDEFONSO, BULACAN_______________ Tel. No. / Mobile No. __09653721693________________
__________________________________________ e-mail address:_joannedbelen@gmail.com___________
Spouse’s Name: ________________________ Citizenship: ______________________________________
Father’s Name: EDWIN DEBELEN___________ Citizenship: ___FILIPINO________________________
Mother’s Maiden Name: ROSARIO DEBELEN____ Citizenship: ______FILIPINO_______________________
Citizenship acq uired by: _________________
√ Birth Election Marriage Naturalization R.A. 9225 Others
× ×
Are you a holder of a foreign passport:YES √ NO
Have you ever been issued a Diplomatic / Official passport: YES √ NO
If YES , indicate latest passport no. : _______ ____________________________
If YES, from what country? ____________________ __ Issuance Date: __________ ________
Place Issued: ______________________
PURPOSE OF TRAVEL:. TRAVELING TO WORK , VISITING MY FRIENDS AND MY FAMILY ___________
__________________ ______________________ ____________________________________________
DATE OF TRAVEL: FEB 15, 2022___________________ ________ ___________________
____________________________________________ _____
DESTINATION: USA____ ____________ ___ TRANSIT / LAY -OVER: _____ ____________
_______________________
REQUEST FOR NOTEVERBALE? YES
√ NO
(FOR VI SA REQUIREMENTS PLEA SE COORDINATE WITH THE CONCERNED
EMBASSY / CONSULATE)
I SOLEMNLY SWEAR UNDER THE PENALTY OF LAW that the statements made on this application form are
true and the a ttached do cuments are authentic. Likewise, I hereby declare th at I have been made aware of the
application requirements and swear to submit all lacking requirements on the date of release. I also acknowledge
all requirements.
that the Department has the right to hold the release of my passport until I have satisfied
_______JOANNE DEBELEN__________
Signature of Applicant
DO NOT WRITE BELOW THIS PART. FOR THE DEPARTMENT OF FOREIGN AFFAIRS’ USE ONLY.
Passport Type: Diplomatic Official Validity: ________
______ Passport Slip No: _____________ ___
Designation:
_______________________________________________________________________________________
___
________ ____________________
_________________________________________ ______ _______________
Received new passport:
Received cancelled passport:
________________________________________
Signature over printed name
_____________________________
___________
Signature over printed
name
REMARKS:
_____________________________
Date
Processor _____________________________
Encoder _____________________________
:
Released by: Approving
___________________________________
Officer :
DOCUMENTARY REQUIREMENTS
FOR NEW APPLICANT
• Personal appearance • Notarized Joint Birth Affidavit of Two
• Duly accomplished application form Disinterested Persons;
• Original PSA Birth Certificate (if details in • Any public document indicating date, place of
birth certificate are unreadable, provide birth and citizenship.
local copy of birth certificate of the same
• Government Issued ID
format. If still unreadable applicant must
provide a transcribed copy of the birth
certificate from the Local Civil Registrar FOR PASSPORT RENEWAL
where the applicant was born / registered) • Personal appearance
or present and submit a photocopy of • Present and submit photocopy of the data page
regular e-passport. of old diplomatic / official e-passport; For those
• For married women, submit also original with passports issued before October 2010,
PSA Marriage Contract (if details in submit original readable PSA Birth Certificate (if
marriage contract are unreadable, provide details in birth certificate are unreadable,
local copy of the marriage contract of the provide local copy of birth certificate of the same
same format. If still unreadable, applicant format. If still unreadable applicant must provide
must provide a transcribed copy of the a transcribed copy of the birth certificate from
marriage contract from the Local Civil the Local Civil Registrar where the applicant
Registrar where the marriage was was born / registered) or present and submit a
registered). photocopy of regular e-passport.
• For married women, submit also original PSA
In Case of No Birth Record Marriage Contract (if details in marriage contract
are unreadable, provide local copy of the
marriage contract of the same format. If still
If born in or after 1950
unreadable, applicant must provide a
• Certificate of Non-availability of Birth Record transcribed copy of the marriage contract from
from the PSA; the Local Civil Registrar where the marriage
• Apply for the delayed registration of birth at was registered).
the local civil registrar;
• Submit original PSA Birth Certificate and FOR LOST PASSPORT
supporting documents indicating date, of • Submit Affidavit of Loss.
birth and citizenship; • If lost passport is still valid, submit Police Report
• Any public document indicating date , place and Affidavit of Loss. There will be a 15-day
of birth and citizenship clearing period prior to the processing of
• Government Issued ID application for a replacement of lost valid e-
passport.
If born before 1950 • Submit same documents required for new
• Certificate of Non-availability of Birth Record passport applicants.
from the PSA;
ADDITIONAL REQUIREMENTS
1. Original and/or Certified True Copy of Signed Travel Authority;
2. Endorsement Letter addressed to DFA (Endorsement Letter is no longer required if Travel Authority is
already addressed to DFA);
3. Letter of Invitation from sponsor / organizer;
4. Original Training Contract if duration of training, fellowship, scholarship and/or study grant is one (1)
month or longer;
5. Original latest Service Record;
6. Original Certificate of No Pending Administrative Case;
7. Certified True Copy of Presidential Full Powers or Appointment Paper (for presidential appointees);
8. Certified True Copy of Approved Civil Service Appointment (for co-terminus appointees);
9. Certified True Copy of Oath of Office (for Elected Officials);
10. Photocopy of Applicant’s Office I.D. and Authorized Representative’s I.D.; and,
11. For transit to countries where visa is required, submit confirmed flight itinerary.
*As required by the US Embassy – Manila, applicants traveling to the United States of America are
requested to provide following documents to pertaining to 1) where official travel will take place,
2) brief description of their duties and responsibilities, and 3) company / organization sponsoring
the travel.
Per Department Order No. 15-10 dated 21 October 2010, the applicable fees for the diplomatic and
official e-Passports are as follows:
Regular processing of Diplomatic/Official e-Passport (7 working days) - P
950.00
Expedite processing of Diplomatic/Official e-Passport (5 working days) - P 1,
200.00
Penalty for lost Diplomatic/Official Passport - P
350.00
REMINDER
The applicant is responsible in securing a visa to his/her country of destination and/or transit. It is
advised that the applicant consult the concerned Embassy or Consulate of the country of
transit/destination for the latest visa and related travel advisories before the date of departure.