"Epassport Application Form - Consulate General of the Philippines" - Milan, Italy

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Download "Epassport Application Form - Consulate General of the Philippines" - Milan, Italy

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NOT FOR SALE
Form No. C‐AP‐EPPT2
REPUBLIC OF THE PHILIPPINES 
CONSULATE GENERAL OF THE PHILIPPINES 
MILAN, ITALY 
 
ePASSPORT APPLICATION FORM
PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK. 
LAST NAME / APELYIDO
FIRST NAME / PANGALAN
__________________________________________________
___________________________________________________________
MIDDLE NAME / GITNANG PANGALAN
PLACE OF BIRTH / POOK NG KAPANGANAKAN
__________________________________________________
___________________________________________________________
GENDER / KASARIAN
DATE OF BIRTH / PETSA NG KAPANGANAKAN (Ex. January 1, 2010)
MALE
FEMALE
___________________________________________________________
CIVIL STATUS:
Single
Married
Widowed/Widower
Annulled/Divorced
Legally Separated
(If married / widowed / annulled / divorced/ legally separated)
Name of Spouse
_________________________ ______________________ __________________________
Citizenship ___________________
Last Name
Middle Name
First Name
Address in Italy/Abroad
Tel. No.
_____________________________________________________________________________
_________________
Street - Number
Town/City
Province
Country
Address in the Philippines
___________________________________________________________________________
Tel. No.
________________
Number - Street
District
Town/City
Province
Name of Father
Citizenship
__________________________ ______________________ __________________________
___________________
Last Name
Middle Name
First Name
Name of Mother
Citizenship
___________________________ ______________________ _________________________
___________________
(before Marriage)
Last Name
Middle Name
First Name
Citizenship Acquired by:
Birth
Election
Marriage
Naturalization
Dual Citizenship (RA 9225)
Others ______________________
Are you a Holder of a Foreign Passport?
Yes
No
Have you ever been issued a Philippine Passport?
Yes
No
If Yes, from what country?
_______________________________
If Yes, latest Passport Number
________________________________
Date of Issue
Place of Issue
___________________
________________
Occupation
______________________________________
Name of Employer
________________________________________________________
Address of Employer
Tel. No
__________________________________________________________________________________
. _________________
In case of accident or death, please notify:
In the Philippines
In Italy
Name ___________________________________
Name _____________________________________
Address ____________________________________________________
Address ________________________________________________________
____________________________________________________
________________________________________________________
Tel. No. _____________________
Tel. No. ___________________________
If this application is filed by another person on behalf of the applicant, indicate name and relationship to applicant.
Name:
Relationship to Applicant:
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The supporting
documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am allowed to
hold only one Philippine passport at any given time. 6) I am aware that making false statement in passport application furnishing falsified or forged
documents in support thereof are punishable by law.
________________________________________
Signature of Applicant
REMARKS:
FOR STRICT COMPLIANCE: Please affix initials.
Processor:
Encoder:
Signing Officer:
NOT FOR SALE
Form No. C‐AP‐EPPT2
REPUBLIC OF THE PHILIPPINES 
CONSULATE GENERAL OF THE PHILIPPINES 
MILAN, ITALY 
 
ePASSPORT APPLICATION FORM
PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK. 
LAST NAME / APELYIDO
FIRST NAME / PANGALAN
__________________________________________________
___________________________________________________________
MIDDLE NAME / GITNANG PANGALAN
PLACE OF BIRTH / POOK NG KAPANGANAKAN
__________________________________________________
___________________________________________________________
GENDER / KASARIAN
DATE OF BIRTH / PETSA NG KAPANGANAKAN (Ex. January 1, 2010)
MALE
FEMALE
___________________________________________________________
CIVIL STATUS:
Single
Married
Widowed/Widower
Annulled/Divorced
Legally Separated
(If married / widowed / annulled / divorced/ legally separated)
Name of Spouse
_________________________ ______________________ __________________________
Citizenship ___________________
Last Name
Middle Name
First Name
Address in Italy/Abroad
Tel. No.
_____________________________________________________________________________
_________________
Street - Number
Town/City
Province
Country
Address in the Philippines
___________________________________________________________________________
Tel. No.
________________
Number - Street
District
Town/City
Province
Name of Father
Citizenship
__________________________ ______________________ __________________________
___________________
Last Name
Middle Name
First Name
Name of Mother
Citizenship
___________________________ ______________________ _________________________
___________________
(before Marriage)
Last Name
Middle Name
First Name
Citizenship Acquired by:
Birth
Election
Marriage
Naturalization
Dual Citizenship (RA 9225)
Others ______________________
Are you a Holder of a Foreign Passport?
Yes
No
Have you ever been issued a Philippine Passport?
Yes
No
If Yes, from what country?
_______________________________
If Yes, latest Passport Number
________________________________
Date of Issue
Place of Issue
___________________
________________
Occupation
______________________________________
Name of Employer
________________________________________________________
Address of Employer
Tel. No
__________________________________________________________________________________
. _________________
In case of accident or death, please notify:
In the Philippines
In Italy
Name ___________________________________
Name _____________________________________
Address ____________________________________________________
Address ________________________________________________________
____________________________________________________
________________________________________________________
Tel. No. _____________________
Tel. No. ___________________________
If this application is filed by another person on behalf of the applicant, indicate name and relationship to applicant.
Name:
Relationship to Applicant:
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The supporting
documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am allowed to
hold only one Philippine passport at any given time. 6) I am aware that making false statement in passport application furnishing falsified or forged
documents in support thereof are punishable by law.
________________________________________
Signature of Applicant
REMARKS:
FOR STRICT COMPLIANCE: Please affix initials.
Processor:
Encoder:
Signing Officer: