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BINIBINING PILIPINAS CHARITIES, INC.

2015 BINIBINING PILIPINAS BEAUTY PAGEANT


OFFICIAL APPLICATION FORM
(Please fill up the form in your own handwriting and submit to the Bb. Pilipinas Secretariat)

BINIBINING PILIPINAS CHARITIES, INC. (BPCI) NEITHER COLLECTS, NOR HAS IT


AUTHORIZED ANY PERSON/ENTITY TO COLLECT ANY FEE IN CONNECTION WITH
THIS APPLICATION.
I. PERSONAL INFORMATION
NAME

NICKNAME

PEN NAME, STAGE NAME, PSUEDONYM

PRESENT ADDRESS

SEX

HOUSE UNIT NO, STREET:

BARANGAY, CITY, PROVINCE


(If more than one address within the last five (5) years, including foreign addresses, kindly indicate the same
below, as well as length of stay and inclusive dates. Attach a separate sheet if necessary)
ADDRESS

LENGTH OF STAY

INCLUSIVE DATES

1.
2.
3.

CONTACT DETAILS
LANDLINE:

CELLPHONE:

EMAIL:

I can most easily be reached/contacted through:

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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c. Status as Immigrant to any Other Country and Details Thereof:


COUNTRY

DATE OF APPLICATION
(If naturalized, date of naturalization)

CURRENT STATUS

d. Application for Naturalization in any other Country and Details Thereof:


COUNTRY

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.

b. Details of Prior Occupation


OCCUPATION

c. Details of all OUSTANDING 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

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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(attach Additional Sheets if necessary).


MEDIA (TV Show, Movie, Pictorial)

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.

PARTICIPATION IN OTHER BEAUTY PAGEANTS


BEAUTY CONTEST/ORGANIZER

TITLE WON

DATE

EDUCATION
SCHOOL/UNIVERSITY

ADDRESS

DEGREE/LEVEL

YEAR
GRADUATED

CONTACT PERSON/
DETAILS

HIGHEST EDUCATIONAL ATTAINMENT:


LANGUAGES/DIALECTS SPOKEN:

OTHER PERSONAL INFORMATION


HOBBIES

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

Is the Parents separation legally documented?

NO

NOTE: If Parents separation is legally documented, please provide VALID ORDER of CUSTODY.

BODY MEASUREMENTS AND INFORMATION


HEIGHT

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):

Other Interesting Personal Information (if any):

II. CERTIFICATION AND WARRANTY OF INFORMATION/STATEMENTS


1. I certify that all of the following information/data and/or matters indicated in this Application Form and
such documents attached hereto are true, and that there are no false statements,
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misrepresentations or omissions herein. Any such false statements, misrepresentations or


omissions will be sufficient ground for BPCI to reject this application, without prejudice to any other
legal remedies BPCI may be entitled to under the premises.
2. I further certify that:
a. I am neither married, nor have I ever been married; I have never sought the annulment of my
marriage or the declaration of nullity thereof, and that I have never been, nor am I presently
pregnant. I have neither given birth to child nor am I a parent;
b. I am in good mental, psychological and physical health, and that I have never been sick or have
been hospitalized for Cancer, Epilepsy, HIV, AIDS, heart ailment, a disease involving the
gastrointestinal system or any other disease that will impair my mental, psychological and/or
physical health or condition;
c.

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;

d. I am of good moral character;


e. I have never participated in any bold/burlesque shows, plays, movies, publications or activities,
or such show, play, movie, publication or activity, which, in the sole opinion and discretion of
BPCI, is inconsistent with my application with the 2015 Pageant, run counter against the social
and moral principles upon which the Pageant is founded upon, and/or bring disrepute or
embarrassment to BPCI or any of its sponsors;
f.

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.

III. DOCUMENTS TO BE SUBMITTED


1. Attached to this Application Form is/are ____ copy(ies) of the following documents, the original of
which I am presenting to the BPCI Corporate Secretariat for comparison and verification:
a. CITIZENSHIP: (Please check applicable Citizenship category)

Natural-Born Citizen
Born In the Philippines

i. Birth Certificate; and


ii. Philippine Passport, if
applicable

Balikbayan Who Re-Acquired


Philippine Citizenship
Under R.A. 9225

i. Birth Certificate or Report


of Birth; and
ii. Identification certificate
issued by the Bureau of
Immigration

Natural-Born Citizen
Born Outside the Philippines

i.

Report of Birth issued


by the Philippine
Consulate in the
country of Birth; or

ii.

NSO certificate stating


that birth was reported
by the Philippine
consulate and recorded
in the Philippines

b. RESIDENCE: (Please check applicable Residence category)


Has NOT Resided Outside the
Philippines

i.

Valid ID Showing
Philippine Address

Has Resided Outside the


Philippines

i.

Valid ID showing Philippine


Address; and

ii.

Any of the following:


a. Philippine Passport;

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b. Foreign Passport; or
c. Certificate from Bureau
of Immigration stating
date of entry into the
Philippines
c.

High School or College Diploma;

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:

Full Body Shot Photo

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.

IV. UNDERSTANDING OF CONDITIONS


1. I understand that I am applying as a candidate of the 2015 Pageant and that the requirements
and/or limitations with regard to age, residency, and citizenship may vary, subject to the
requirements of different international pageants, and accordingly, that my qualifications are further
subject thereto.
2. I am aware that BPCI, at its sole discretion, may require me to submit additional and sufficient proof
of age, residency, citizenship, health and other documentation/information regarding my
qualifications. Should I be required to do so, I undertake to provide BPCI with such requested
documentation information, and failing to comply within the period to submit, as determined by BPCI,
I understand that my application will not be considered complete and submitted.
3. I understand that I have to pass the screening and meet all the requirements of BPCI and the
qualifications of the different international pageants before I can qualify as a candidate of the 2015
Pageant. I further understand that the basic requirements relate to information obtained from me as
contained in this Application Form
4. In considering my application to be a candidate of the 2015 Pageant, I also understand that personal
achievements, intelligence, beauty, physical fitness, personal style and charisma, among other
criteria, shall also be considered. I agree that all issues as to my eligibility as an applicant shall be
determined solely by BPCI and that I shall abide by its determination, which shall be final and nonappealable.
5. In filling out and signing this Application Form, I further understand that BPCI is under no obligation
to accept me as a candidate. My acceptance as an official candidate shall commence only when I
am formally and specifically notified thereof.
6. If I am chosen as an official candidate, this Application Form shall be considered part and parcel of
the Official Entry Form/Contract which I shall be required to sign.
7. I understand that in signing this Application Form, I have accepted the sole discretion of BPCI to
accept or reject me as a candidate of the 2015 Pageant and that the decision of BPCI on this
application is final and non-appealable.

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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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