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BI FORM 2014-01-005 Rev 0

This document may be reproduced and is NOT FOR SALE

PETITION FORM FOR RETENTION/RE-ACQUISITION OF


PHILIPPINE CITIZENSHIP UNDER R.A. 9225

PETITION
I, ____________________________________________________________________________,
[Name in Philippine Document]

also known as _______________________________________________________, _____ years of age,


[Name in foreign passport]

male/female, am single/widowed/divorced/annulled/separated/married to _________________________


(underline applicable)

____________________________. I, a citizen of _________________and resident of _______________


____________________________________________ with contact number ______________________,
after being sworn to in accordance with law, hereby declare under oath that:
1. I am a former natural-born Philippine citizen, born on ___________________________________
[DD-MMM-YYYY e.g. 01 JAN 1990]

at ___________________________to _______________________________________________,
[Fathers name]

[as appearing in Philippine document]

_______________________________citizen by birth/election/marriage/naturalization, who was


[Fathers citizenship at the time of petitioners] birth

[at the time of the petitioners birth(underline applicable)]

married/not married to ___________________________________________________________,


[Mothers name]

_____________________________citizen by birth/election/marriage/naturalization;
[Mothers citizenship at the time of petitioners birth]

[at the time of petitioners birth (underline applicable)]

2. I lost my Philippine citizenship when I became a citizen of ________________________________


on _____________________. Presently, I am a holder of a valid ___________________ passport
with number _________________ issued on ___________________ at ____________________;
[DD-MMM-YYYY e.g. 01 JAN 1990]

3. I took my Oath of Allegiance to the Republic of the Philippines on __________________________


[DD-MMM-YYYY e.g. 01 JAN 1990]
at _______________________________;
(If the petitioner is a registered alien with the Bureau of Immigration):
4. I surrender for cancellation my original
Alien Certificate of Registration (ACR)
no. _______________________and/or Immigrant Certificate of Residence/Certificate of Residence
for Temporary Visitors (ICR/CRTV) no. _________________________;
(If with Dependent/s):
5. Included in this petition is/are my unmarried child/ren below eighteen (18) years of age, namely:
Name

Gender

_______________________________________
_______
_______________________________________
_______
_______________________________________
_______
(Please use BI Form 2014-01-006 Rev 0 for each dependent to

WHEREFORE, it is prayed that this petition for


Retention and/or Re-acquisition of Philippine
Citizenship under Republic Act No. 9225 be
GRANTED.

Date of Birth

Age

________________________
________________________
________________________
be attached to this petition.)

_____
_____
_____

[DD-MMM-YYYY e.g. 01 JAN 1990]

Attach your 2x2 colored


photographwith white
background using
permanent glue in the
photograph box.
The photograph must be taken
within the last three (3) months
from the date of application.

____________________________________________________

Signature over Printed Name


__________________________________________
Date [DD-MMM-YYYY e.g. 01 JAN 1990]

A scanned photograph is not


allowed. A photograph of the
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses,
etc.) or headwear is not acceptable.

VERIFICATION
I certify under oath that the above statements are true and correct to my own personal knowledge, and based on authentic
documents in my possession.
________________________________________
Applicants Signature over Printed Name

SUBSCRIBED AND SWORN TO before me this ______________ in _______________________, Petitioner personally


appeared and exhibited to me his/her passport with number _____________________ issued on ____________________________
at __________________.
Doc No.: _________
Page No.: ________
Book No.: ________
Series of ________
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