FA Form NO. 79 "Passport Application Form - Jakarta Pe" - Philippines

FA Form NO. 79 or the "Passport Application Form - Jakarta Pe" 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 - Jakarta Pe" - Philippines

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Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
Post: JAKARTA PE
PASSPORT APPLICATION FORM (FA FORM NO. 79)
PLEASE DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE 
PROVIDING FALSE STATEMENTS IN PASSPORT APPLICATION IS PUNISHABLE BY LAW (RA NO. 8239) 
 
_______________________________________  
       ___________________________________________________ 
 
                
Last Name/Apelyido 
LAST NAME / Apelyido
FIRST NAME / Pangalan (Jr.) / II /III
 
________________________________________ 
       ___________________________________________________ 
 
 
 
 
 
 
 
 
MIDDLE NAME / Gitnang Pangalan
PLACE OF BIRTH / Pook ng Kapanganakan
 
   
 
_________________________________________
 
GENDER
MALE
FEMALE
                             
Month
/ Day /
Year
DATE OF BIRTH / Petsa ng Kapanganakan
:
[ ] Single [ ] Married [ ] Widow/er [ ] Legally Separated [ ] Annulled [ ] Divorced
Civil Status
Complete Address in the Philippines __________________________________________________________________ 
___________________________________________________________  Abroad : ____________________________
__________________________________________________________________________________________           
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 ID No. (TIN) _______________ Overseas Employment Certificate (OEC) No.
(If any)
  ________________________  
   
Driver’s License No. __________________________ PAG-IBIG ID No. ________________________________
PHILHEALTH ID No. _______________________ Community Tax Cert. (
. ___________________
CEDULA) No
‘‐      ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐     ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐    
 
Name of Wife / Husband : __________________________________________ Citizenship ________________
Complete Address in the Philippines or Abroad _________________________________________________
__________________________________________________________________________________________
Tel. No. _______________ Mobile No. ___________________ E-mail Address ________________________
‘-
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Name of Father: _________________________________________________ Citizenship _________________
Maiden / Single Name of Mother ____________________________________ Citizenship_________________
Complete Address in the Philippines __________________________________________________________
__________________________________________________________________________________________
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 [ ] Marriage [ ] Naturalization
[ ] RA 9225
[ ] Others: _______________________
 
 
Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
Post: JAKARTA PE
PASSPORT APPLICATION FORM (FA FORM NO. 79)
PLEASE DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE 
PROVIDING FALSE STATEMENTS IN PASSPORT APPLICATION IS PUNISHABLE BY LAW (RA NO. 8239) 
 
_______________________________________  
       ___________________________________________________ 
 
                
Last Name/Apelyido 
LAST NAME / Apelyido
FIRST NAME / Pangalan (Jr.) / II /III
 
________________________________________ 
       ___________________________________________________ 
 
 
 
 
 
 
 
 
MIDDLE NAME / Gitnang Pangalan
PLACE OF BIRTH / Pook ng Kapanganakan
 
   
 
_________________________________________
 
GENDER
MALE
FEMALE
                             
Month
/ Day /
Year
DATE OF BIRTH / Petsa ng Kapanganakan
:
[ ] Single [ ] Married [ ] Widow/er [ ] Legally Separated [ ] Annulled [ ] Divorced
Civil Status
Complete Address in the Philippines __________________________________________________________________ 
___________________________________________________________  Abroad : ____________________________
__________________________________________________________________________________________           
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 ID No. (TIN) _______________ Overseas Employment Certificate (OEC) No.
(If any)
  ________________________  
   
Driver’s License No. __________________________ PAG-IBIG ID No. ________________________________
PHILHEALTH ID No. _______________________ Community Tax Cert. (
. ___________________
CEDULA) No
‘‐      ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐     ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐   ‐    
 
Name of Wife / Husband : __________________________________________ Citizenship ________________
Complete Address in the Philippines or Abroad _________________________________________________
__________________________________________________________________________________________
Tel. No. _______________ Mobile No. ___________________ E-mail Address ________________________
‘-
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Name of Father: _________________________________________________ Citizenship _________________
Maiden / Single Name of Mother ____________________________________ Citizenship_________________
Complete Address in the Philippines __________________________________________________________
__________________________________________________________________________________________
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 [ ] Marriage [ ] Naturalization
[ ] RA 9225
[ ] Others: _______________________
 
 
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Have you ever been issued a Philippine
Are you a holder of a foreign passport?
[ ] Yes
[ ] No
Passport?
[ ] Yes
[ ] No
If Yes, from what country? ______________
Latest passport Number:_________________
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 I provided in this application is 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 (FOR MINOR APPLICANTS)
PLEASE DO NOT WRITE BELOW THE LINE
----------------------------------------------------------------------------------------------------------------------------------------
REMARKS:
Processor:
Encoder:
Signing Officer:
RECEIVED CANCELLED PASSPORT:
RECEIVED NEW PASSPORT:
FOR ADMINISTRATIVE USE ONLY:
For more details, please visit www.dfa.gov.ph
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