Beruflich Dokumente
Kultur Dokumente
NICKNAME
PRESENT ADDRESS
SEX
LENGTH OF STAY
INCLUSIVE DATES
1.
2.
3.
CONTACT DETAILS
LANDLINE:
CELLPHONE:
EMAIL:
AGE
PLACE OF BIRTH:
DATE OF BIRTH:
CITIZENSHIP
a. Citizenship In Any Country and Details Thereof:
COUNTRY
NATURAL/NATURALIZED
(If naturalized, date of naturalization)
CURRENT STATUS
b. Petitioned as Resident or Application for Residency in any Other Country and Details Thereof:
COUNTRY
NATURAL/NATURALIZED
(If naturalized, date of naturalization)
CURRENT STATUS
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DATE OF APPLICATION
(If naturalized, date of naturalization)
CURRENT STATUS
DATE OF APPLICATION
CURRENT STATUS
PASSPORT DETAILS
Place Issued:
Date Issued:
Valid until:
Details of Foreign Passport or any other Foreign Travel Document (if any):
OCCUPATION
a. Details of Present Occupation
OCCUPATION
EMPLOYMENT ADDRESS
CONTACT NO.
EMPLOYMENT ADDRESS
CONTACT NO.
WITH WHOM
LENGTH OF EFFECTIVITY
d. Details of all PAST Contracts, Talent Management and Similar Agreements, Sponsorships,
Endorsements and the like, whether Written or Oral, with Whom Entered Into and the Length of
Effectivity thereof (attach Additional Sheets if necessary).
CONTRACT DESCRIPTION
WITH WHOM
LENGTH OF EFFECTIVITY
e. I Have Appeared and/or Currently Appear in the Following TV Show(s), Movie(s) and/or Pictorial(s)
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ROLE
INCLUSIVE DATES
NOTE: For items (c), (d) and (e) of OCCUPATION, the APPLICANT is REQUIRED to DISCLOSE ALL PRESENT
and PAST Contracts, Talent Management and Similar Agreements, Sponsorships, Endorsements and
the like, including Fashion Shows and/or Print and Video Modeling Jobs and PROVIDE BPCI with
copies of Media the Applicant has appeared in.
TITLE WON
DATE
EDUCATION
SCHOOL/UNIVERSITY
ADDRESS
DEGREE/LEVEL
YEAR
GRADUATED
CONTACT PERSON/
DETAILS
SPORTS ACTIVITIES
TALENTS/SKILLS
HANDLER
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FAMILY BACKGROUND
NAME
OCCUPATION
ADDRESS
CONTACT NOS.
FATHER
MOTHER
GUARDIAN
(if any)
If Parents are separated, who has legal custody (if Applicant is a minor):
YES
NO
NOTE: If Parents separation is legally documented, please provide VALID ORDER of CUSTODY.
WEIGHT
BUST
HAIR COLOR
WAIST
EYE COLOR
HIPS
PERSONAL REFERENCES
(Provide At Least 3 References who are NOT Relatives)
NAME
ADDRESS
CONTACT NOS.
1.
2.
3.
4.
Reason/s for Applying for the 2015 Binibining Pilipinas Beauty Pageant (the 2015 Pageant):
I am neither suffering from, nor have I ever been under prolonged medication for any physical,
neurological, psychological or psychiatric condition, including eating and/or personality disorders
which will impair my ability to act as an Applicant and/or Candidate of the 2015 Pageant;
I have not engaged in prostitution or any such act which can be deemed as similar or related
thereto;
g. I am neither a party to any existing Contract, which would, in the sole opinion and discretion of
BPCI, shall cause my disqualification as an Applicant to, or a Candidate of, the 2015 Pageant.
h. I was born with the anatomy of a female and that I have not consented to and/or underwent any
surgical, medical and/or cosmetic procedure to transform me into a biological female.
Natural-Born Citizen
Born In the Philippines
Natural-Born Citizen
Born Outside the Philippines
i.
ii.
i.
Valid ID Showing
Philippine Address
i.
ii.
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b. Foreign Passport; or
c. Certificate from Bureau
of Immigration stating
date of entry into the
Philippines
c.
d. Medical Certificate for both my Physical and Mental health and well-being; and
e. Certificate of Good Moral Character given by my School, Church or Professional Organization.
2. In addition to the documents listed above, I also submit two (2) photographs, one close-up and one
full body shot.
(To be accomplished by BPCI)
Received:
Close Up Photo
Received:
3. I hereby authorize BPCI to verify the truth of all my assertions herein and the genuineness/validity of
all the documents I have submitted, thereby waving for these purposes the provisions of all laws,
rules and regulations, local or foreign, relating to the privacy or confidentiality of the matters
hereunder.
4. I warrant that the documents I have submitted are public documents in my possession or which
came into my possession legally and/or are public documents attested to by the officer/s having the
legal custody of the records, and that, where applicable, the entries therein were made in the regular
performance of an official duty, and that I will hold BPCI free and harmless from a breach of this
Warranty.
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8. I finally certify that I have read this Application Form carefully, that I have understood the same, and
that no promises or representations were made to induce me to sign this Application Form.
APPLICANT
(Signature Over Printed Name)
Signature/s above printed names of both Parent/s (Custodial Parent if Separated or if parent is
Solo Parent) or of Legal Guardian, if applicant is a minor:)
FATHER
MOTHER
LEGAL GUARDIAN
Date:
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