DEPARTMENT OF FOREIGN AFFAIRS

PHILIPPINE EMBASSY
Post: Abu Dhabi

PASSPORT APPLICATION FORM (FA FORM NO. 79)

THIS APPLICATION FORM IS NOT FOR SALE.
PLEASE DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE.
PROVIDING FALSE STATEMENT IN PASSPORT, APPLICATION IS PUNISHABLE BY LAW (R.A. NO. 8239) Page 1 of 2

__________________________________ ________________________________
LAST NAME / APILYEDO FIRST NAME / PANGALAN (JR. / III)

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

_______________ / _________ /_________ GENDER / KASARIAN: MALE

MONTH DAY YEAR
DATE OF BIRTH / PETSA NG KAPANGANAKAN FEMALE
(Ex. April 25, 2014)

Civil Status: [ ] SINGLE [ ] MARRIED [ ] WIDOW/ER [ ] LEGALLY SEPARATED [ ] ANNULED [ ] DIVORCED

Complete Address in the PHILIPPINES: ___________________________________________________________________

___________________________________________________________________
Tel No. _______________________ Mobile No. ______________________ E-mail Address: _________________________
Present Occupation: _________________________ Employer: _________________________________________________
Work Address in Philippines or Abroad: ____________________________________________________________________
____________________________________________________________________
Tel No. _______________________ Fax No. _______________________ E-mail Address: ___________________________
SSS No. ____________________________ OWWA Membership ID No. __________________________________ (if any)
Tax Identification No. (TIN) ________________ Overseas Employment Certificate (OEC) No. __________________ (if any)
Drivers License No. ________________________ PAG-IBIG ID. No. ____________________________________________
PHILHEALTH ID No. _____________________ Community Tax Certificate (CEDULA) No. ___________________________

Name of Wife / Husband: __________________________________________ Citizenship: ___________________________

Complete Address in the PHILIPPINES: ___________________________________________________________________
___________________________________________________________________
Tel No. _______________________ Mobile No. ______________________ E-mail Address: _________________________

Name of Father: _________________________________________________ Citizenship: ___________________________

Maiden/Single Name of Mother _____________________________________ Citizenship: ___________________________
Complete Address in the PHILIPPINES: ___________________________________________________________________
___________________________________________________________________

For passport Renewal: 02 639 0006 Local 215/200

Email Address: auhpe@philembassy.ae For more details, please visit www.dfa.gov.ph
 DEPARTMENT OF FOREIGN AFFAIRS
PHILIPPINE EMBASSY
Post: Abu Dhabi

Tel No. _______________________ Mobile No. ______________________ E-mail Address: _________________________

In case of emergency name of next-of-kin (NOK) to be contacted: _______________________________________________

Complete Address in the PHILIPPINES: ___________________________________________________________________
___________________________________________________________________
Tel No. _______________________ Mobile No. ______________________ E-mail Address: _________________________

Citizenship Acquired By: [ ] Birth [ ] Election [ ] Naturalization [ ] R.A. 9225

Are you a holder of foreign passport: [ ] YES [ ] NO Have you been issued a Philippine
Passport? [ ] YES [ ] NO
If YES, latest Passport Number.
If YES, from what country?
_______________________________________________ Date of Issue:

Place of Issue:

For Applicants below 18 years old ONLY:

Name of Minors Traveling Companion: __________________________________________________________________
Companions Relationship to the Minor: __________________________________________________________________
Complete Address: ___________________________________________________ Telephone No. __________________

I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information 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 Applicant or Legal Guardian (of minor applicants)

FOR USE OF THE DEPARTMENR OF FOREIGN AFFORS ONLY. PLEASE DO NOT WRITE BELOW THIS LINE.
................................................................................................................
REMARKS:

Processor: Encoder: Signing: Transmission Officer:

RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:

FOR ADMINISTRATIVE USE ONLY:

For passport Renewal: 02 639 0006 Local 215/200

Email Address: auhpe@philembassy.ae For more details, please visit www.dfa.gov.ph