Step * Have your appointment verified at the verification section.

Present your duly accomplished application form, an ID, and your e-receipt. Please double check that the verifier has signed or stamped your form before proceeding to the next step.

Step 2 Present your verified application form and requirements to the processor. Please note that you MAY be required to present other requirements. There is no 100% guarantee your application will be approved on the same day. If approved, double check that the processor has signed your form. Step 3 Once approved, proceed to the data capturing / encoding section. Please remove all hair accessories, colored contact lenses, piercings on the face and ears while waiting your turn.

When your photo has been captured and your information encoded, please double check that all information entered is complete and correct. Step 4

(optional)

You may opt in for courier services. Please approach any of the couriers inside the capture site.

Important Reminders

Your appointment is on Thursday, Oct 04, 2018 at 12:00 - 13:00. Please be at DFA NCR North (Robinsons Novaliches) 15-30 minutes before your scheduled appointment.

Please make sure you have prepared all the requirements. You may refer to https://consular.dfa.gov.ph/passport Processing fee is non-refundable and non-transferrable. Be ready with both the original and photocopies of your documents during your appointment. Application processing may be delayed if applicants are not ready with copies of their documents once inside the data capturing site. For your NSO/PSA Certificate requirements, you may contact https://www.ecensus.com.ph/

Kindly print your duly accomplished application form (with barcode) and e-receipt on A4-size paper. You must have a printed application form and e-receipt to show and submit at your chosen application site.

Steps at the Data Capturing Site

Reminders

Please wear clothing that will cover your shoulders. Avoid wearing strapless, spaghetti-strapped, or tank tops; halters; backless; see-through or cut-out tops; and deep necklines. Please do not wear shorts, shorts skirts. Please wear shoes. Remember, you are entering a government office. Please dress appropriately.

You want to look good in your passport photo, but please do not put on heavy or theatrical make-up. This may result with you having to remove your make-up during the photo. Republic of the Philippines

E-Receipt No:

PAID

DEPARTMENT OF FOREIGN AFFAIRS

PASSPORT APPLICATION FORM

THISAPPLICATION FORM IS NOT FOR SALE.PLEASEDO NOT LEAVEANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE. PROVIDING FALSE STATEMENTS IN PASSPORT APPLICATIONSIS PUNISHABLE BY LAW (R.A. 8239). Civil Status: Single Married Widow/er Legally Separated Annulled Complete Address: Tel. No.: Present Occupation: Mobile No.: Work Address: Tel. No.: E-mail Address: Name of Wife / Husband: Citizenship: Name of Father: Citizenship: Maiden/Singlename ofMother: Citizenship: Citizenship Acquired By:

Birth Election Marriage Naturalization R.A. 9225 Others Are youa holder of a foreign passport? Yes No

If Yes, from what country?

Have you ever been issued a Philippine Passport? Yes No If Yes, latest Passport Number? Date of issue: Place of issue:

(For applicants below 18 years old ONLY)

Name of minor’s travelling companion: Companion’srelationship: Contact Number: I SOLEMNLY SWEARthat 1) I am a Filipino citizen. 2) The information I provided in this application are true and correct. 3) The supporting documents attached are authentic. 4) I am aware that under the law, I am allowed to hold only one Philippine passport at any given time. 5) I am aware that making false statements in passport application, furnishing falsified or forged documents in support thereof are punishable by law.

Signature of Applicantor LegalGuardian (for minor applicants) FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRSONLY. PLEASE DO NOT WRITE BELOW THIS LINE. REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer: RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT: FOR ADMINISTRATIVE USE ONLY:

Formoredetailsplease visitwww.dfa.gov.phorwww.passport.gov.ph LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III) MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN / / GENDER/ KASARIAN MALE FEMALE Month Day Year

DATE OF BIRTH/ PETSA NG KAPANGANAKAN

(Ex.: March8, 2010)

WCS-RRR-LVJZ-PPT-DORev. October2015

ORGAN DONATION (Optional)

In case of death, I hereby donate [ ] Any organ / tissue [ ] Specific organ to save other people. Please immediately notify my family at mobile / tel. no. . APPOINTMENT DETAILS:

DFA NCR North (Robinsons

Novaliches)

Thursday, 12:00 - 13:Oct 00 04, 2018

PASCUAL LUIS JR.

PIGAR PHILIPPINES /ORMOC, LEYTE

MAY 20 1982

115EVERLASTING ST.BARANGAY PAYATAS, QUEZON CITY, LEYTE +639********* WAREHOUSE PERSONEL +094********

21ST FLOOR TIMES PLAZA BUILDING UN AVENUE ERMITA.MANILA +639********* adjjwy@r.postjobfree.com

LUIS SR. DE GUZMAN PASCUAL PHL

EVELYN METRAN PASCUAL PHL

x N/A

EVELYN PASCUAL/ +639********…

180*******

DFA COPY

Republic of the Philippines

DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO.

PAYMENT DETAILS:

MERCHANT:

BRANCH CODE:

REFERENCE NO:

DATE:

TIME:

APPOINTMENT NUMBER:

NAME:

SITE NAME:

TRANSACTION:

PROCESSING TYPE:

MODE OF PAYMENT:

SERVICE NUMBER:

AMOUNT

180*******

BAYD

2783

DFNGTHUPJ4

20-August-2018

03:35:20 PM

04232018100400340

LUIS JR. PASCUAL

DFA NCR NORTH (ROBINSONS NOVALICHES)

PASSPORT PROCESSING

EXPRESS

CASH

180*******

(E-PASSPORT FEE) P 950.00

(EXPEDITE FEE) P 250.00

APPLICANT

COPY

Republic of the Philippines

DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO.

PAYMENT DETAILS:

MERCHANT:

BRANCH CODE:

REFERENCE NO:

DATE:

TIME:

APPOINTMENT NUMBER:

NAME:

SITE NAME:

TRANSACTION:

PROCESSING TYPE:

MODE OF PAYMENT:

SERVICE NUMBER:

AMOUNT

180*******

BAYD

2783

DFNGTHUPJ4

20-August-2018

03:35:20 PM

04232018100400340

LUIS JR. PASCUAL

DFA NCR NORTH (ROBINSONS NOVALICHES)

PASSPORT PROCESSING

EXPRESS

CASH

180*******

(E-PASSPORT FEE) P 950.00

(EXPEDITE FEE) P 250.00

Contact this candidate