FA Form NO. 79 "Passport Application Form - Philippine Embassy Kuala Lumpur" - Philippines

FA Form NO. 79 or the "Passport Application Form - Philippine Embassy Kuala Lumpur" is a form issued by the Philippine Department of Foreign Affairs.

Download a PDF version of the latest FA Form NO. 79 down below or find it on the Philippine Department of Foreign Affairs Forms website.

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Download FA Form NO. 79 "Passport Application Form - Philippine Embassy Kuala Lumpur" - Philippines

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Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
Post: Philippine Embassy Kuala Lumpur
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 statements in this passport application is punishable by law (R.A No. 8239).
LAST NAME / APELYIDO
FIRST NAME / PANGALAN
PLACE OF BIRTH / POOK NG KAPANGANAKAN
MIDDLE NAME / GITNANG PANGALAN
__________________ / _________ / ___________
Month
Day
Year
[
] Male
[
] Female
DATE OF BIRTH / PETSA NG KAPANGANAKAN
GENDER / KASARIAN
( e.g., April / 25 / 2014 )
Civil Status: [ ] Single
[ ] Married
[ ] Widow/er
[ ] Legally Separated
[ ] Annulled
[ ] Divorced
Complete Address in the Philippines _________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
Present Occupation________________________________________________________________________
Work Address in the Philippines or Abroad____________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
SSS No. ___________________ OWWA Membership ID No. (if any)_________________________________
Tax Identification No. (TIN) _________ Overseas Employment Certificate (OEC) No. (if any) _______________
Driver’s 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. ____________________ Email _______________________
Name of Father _________________________________________________ Citizenship ________________
Maiden / Single Name of Mother ____________________________________ Citizenship________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________
Mobile No. ____________________ Email _______________________
In case of emergency, name of Next-of-Kin (NOK) to be contacted: __________________________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________
Mobile No. ____________________ Email _______________________
Citizenship Acquired By:
[ ] Birth [ ] Election [ ] Marriage [ ] Naturalization [ ] R.A. 9225 [ ] Others ___________________
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Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
Post: Philippine Embassy Kuala Lumpur
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 statements in this passport application is punishable by law (R.A No. 8239).
LAST NAME / APELYIDO
FIRST NAME / PANGALAN
PLACE OF BIRTH / POOK NG KAPANGANAKAN
MIDDLE NAME / GITNANG PANGALAN
__________________ / _________ / ___________
Month
Day
Year
[
] Male
[
] Female
DATE OF BIRTH / PETSA NG KAPANGANAKAN
GENDER / KASARIAN
( e.g., April / 25 / 2014 )
Civil Status: [ ] Single
[ ] Married
[ ] Widow/er
[ ] Legally Separated
[ ] Annulled
[ ] Divorced
Complete Address in the Philippines _________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
Present Occupation________________________________________________________________________
Work Address in the Philippines or Abroad____________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________ Mobile No. ____________________ Email _______________________
SSS No. ___________________ OWWA Membership ID No. (if any)_________________________________
Tax Identification No. (TIN) _________ Overseas Employment Certificate (OEC) No. (if any) _______________
Driver’s 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. ____________________ Email _______________________
Name of Father _________________________________________________ Citizenship ________________
Maiden / Single Name of Mother ____________________________________ Citizenship________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________
Mobile No. ____________________ Email _______________________
In case of emergency, name of Next-of-Kin (NOK) to be contacted: __________________________________
Complete Address in the Philippines____________________________________________________________
_________________________________________________________________________________________
Tel. No. ____________________
Mobile No. ____________________ Email _______________________
Citizenship Acquired By:
[ ] Birth [ ] Election [ ] Marriage [ ] Naturalization [ ] R.A. 9225 [ ] Others ___________________
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Are you a holder of a foreign passport?
Have you ever been issued a Philippine Passport?
[
] YES
[
] NO
[
] YES
[
] NO
If YES, from what country?
If YES, please provide:
Latest Passport No. ______________________________
________________________________________
Date of Issue ___________________________________
Place of Issue __________________________________
For Applicants below 18 years old ONLY
Name of Minor’s Traveling Companion __________________________________________________________
Companion’s Relationship to the Minor _________________________________________________________
Complete Address ________________________________________________ Tel. 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 are authentic; 4) I am aware that under the law I am allowed to hold only one
Philippine Passport at any given time; and, 5) I am aware that making false statements in this passport
application, furnishing falsified or forged documents in support thereof are punishable by law.
Signature of Applicant or Legal Guardian (for minor applicants)
FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRS 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 more details, please visit
www.dfa.gov.ph
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