Beruflich Dokumente
Kultur Dokumente
SURNAME
Apelyido
GIVEN NAME
Pangalan (Jr./ II/ III etc.) Paste one
4.5 cm. X
3.5 cm.
colored
MIDDLE NAME/MAIDEN NAME
Panggitnang Apelyido/ photo with
ROYAL
BLUE
DATE OF BIRTH ___________________________________ SEX □ Male
□ Female background
PLACE OF BIRTH __________________________________
NAME OF FATHER_________________________________ Citizenship _____________________
NAME OF MOTHER_________________________________ Citizenship _____________________
Civil Status: □ Single □Married □Widowed □Divorced □Legally Separated □Annulled
If you are married, state the name of your spouse; if you are divorced/had your marriage annulled, or if you are widowed, state the name of
your former spouse _____________________________________ Citizenship __________________________
ADDRESS IN JAPAN
____________________________________________________________________________ Telephone No. ____________________
Postal Code Prefecture City District/Town/Ward Street Apartment Name/Building Room/Floor Number and/or Cellphone _________________
ADDRESS IN THE PHILIPPINES
____________________________________________________________________________ Telephone No. ____________________
Number Street Barangay Town/City Province/Region ZIP Code and/or Cellphone __________________
VISA CATEGORY/ STATUS OF RESIDENCE (Please select and check one)
□Transit (Stopover, Seaman) □Specified (Designated Activities, Spouse or child of Japanese National, □General □Official/Diplomat
(Cultural Activities, College Student,
Spouse or Child of Permanent Resident, Long‐term Resident ) Pre‐college Student, Trainee, Dependent) (Official, During Mission )
OCCUPATION _________________ WORK ADDRESS______________________________________ TELEPHONE No._______________
Are your parents married? □ Yes □ No Have you been ever issued a
Philippine Passport? □ Yes □ No
Philippine citizenship acquired by: If yes, please provide latest passport number ______________
□ Birth □ Election □ Reacquisition (RA9225)
□ Naturalization □ Marriage Place of Issue_________________ Date of Issue ___________
Natural Color of Eyes ________ Natural Color of Hair _______
Are you an employee of
the Philippine Government? □ Yes □ No Height (in meters) _________ Distinguishing Mark__________
Do you have a valid passport issued by other countries? □ Yes □ No If yes, what country/ies? _____________________________
In the event of an emergency please provide contact details of parties to be notified.
In the Philippines: Name _______________________ Address ______________________Telephone ____________ Relation ________
In Japan: Name _____________________ Address _______________________________ Telephone ____________ Relation ________
FOR STRICT COMPLIANCE: (Embassy Personnel only)
I SOLEMNLY SWEAR, under pain of perjury, Remarks:
that the attached photograph are mine, and
that the statements made on this form are true Attach 2 4.5 cm
Processor: __________________
and the attached documents are authentic X 3.5 cm.
SO HELP ME GOD.
colored photo
with ROYAL
BLUE Signing
background
Officer: _____________________
▲Left Thumbmark ▲Right Thumbmark
Received New Passport:
►_______________________________________
DO NOT
Signature of Applicant PERFORATE PHOTOS
Note: Application Form and copies of supporting documents submitted will be retained by the Embassy. Application received and paid for, and later withdrawn or denied are not reimbursable.