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Important Reminders


Your appointment is on Thursday, May 10, 2018 at 10:00 - 11:00.
Please be at Butuan at least thirty (30) minutes before your scheduled appointment.

☐ Please make sure you have prepared all the requirements.


Be ready with both the original and photocopies of your documents when you
appear for personal appearance. Application processing may be delayed if
applicants are not ready with copies of their documents once inside the data
capturing site.

☐ For your NSO certificate requirements, you may call (02) 737-1111. Nationwide
delivery within 3-4 days.


Kindly print your application form (with barcode) in A4-size paper.
You must have a printed application form to show and submit at your chosen
application site.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
Butuan DEPARTMENT OF FOREIGN AFFAIRS
Thursday, May 10, 2018
10:00 - 11:00 PASSPORT APPLICATION FORM
THISAPPLICATIONFORMIS NOT FORSALE. PLEASEDONOT LEAVEANY SPACES BLANK, INDICATE N/AIF NOT APPLICABLE. PROVIDINGFALSE
STATEMENTS INPASSPORT APPLICATIONSIS PUNISHABLE BY LAW(R.A. 8239).

_______________________________________
CALLO ___________________________________________
ADELYND AUDREY ROSE
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
VERALLO ________________________________________________
PHILIPPINES /CEBU CITY
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
SEPTEMBER / __________
07 / ___________
1985 GENDER/ KASARIAN □ MALE □ FEMALE
Month Day Year
DATE OF BIRTH/ PETSA NG KAPANGANAKAN
(Ex.: March8, 2010)

Civil Status: □ Single □ Married □ Widow/er □ Legally Separated □ Annulled


Complete Address: VERALLOADELYND@YAHOO.COM,
________________________________________________________
CEBU CITY, CEBU Tel. No.:____________________
+09192009050
Present Occupation:SUBJECT
_______________________________________________________
MATTER EXPERT Mobile No.:_________________
+09192009050
Work Address: ____________________________________________________________
10TH FLR. I2 BLDG. IT PARK APAS LAHUG CEBU CITY Tel. No.:____________________
+634119010
E-mail Address: VERALLOADELYND@YAHOO.COM
_______________________________________________________________________________________
Name of Wife / Husband: RAYMOND
____________________________________________________
NIKKI SAGARINO CALLO Citizenship:PHL
_________________
Name of Father: ROMEO
___________________________________________________________
ESCOLAR VERALLO Citizenship:PHL
_________________
Maiden/ Single name of Mother:GEORGIA
______________________________________________
CABANADA TABAR Citizenship:PHL
_________________

Citizenship Acquired By:


□ Birth □ Election □ Marriage □ Naturalization □ R.A. 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? _______________________
XX5551280
Date of issue: _________________
02-17-2010 Place of issue: DFA
__________
CONSULAR O…
(For applicants below 18 years old ONLY)
Name of minor’s travelling companion: ________________________________________________________________
Companion’s relationship: _________________________ Contact Number: __________________________________

I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application are 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)

ORGAN DONATION (Optional)


In case of death, I hereby donate [ ] Any organ / tissue [x ] Specific organ N/A
____________________ to save other people.
Please immediately notify my family at mobile / tel. no. RAYMOND
___________________________.
NIKKI S.CALLO/ +0932…

FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRSONLY. PLEASE DO NOT WRITE BELOWTHIS LINE.

REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer:


RECEIVEDCANCELLED PASSPORT: RECEIVEDNEWPASSPORT:
FOR ADMINISTRATIVE USE ONLY:
For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph
Important Reminders


Your appointment is on Thursday, May 10, 2018 at 10:00 - 11:00.
Please be at Butuan at least thirty (30) minutes before your scheduled appointment.

☐ Please make sure you have prepared all the requirements.


Be ready with both the original and photocopies of your documents when you
appear for personal appearance. Application processing may be delayed if
applicants are not ready with copies of their documents once inside the data
capturing site.

☐ For your NSO certificate requirements, you may call (02) 737-1111. Nationwide
delivery within 3-4 days.


Kindly print your application form (with barcode) in A4-size paper.
You must have a printed application form to show and submit at your chosen
application site.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
Butuan DEPARTMENT OF FOREIGN AFFAIRS
Thursday, May 10, 2018
10:00 - 11:00 PASSPORT APPLICATION FORM
THISAPPLICATIONFORMIS NOT FORSALE. PLEASEDONOT LEAVEANY SPACES BLANK, INDICATE N/AIF NOT APPLICABLE. PROVIDINGFALSE
STATEMENTS INPASSPORT APPLICATIONSIS PUNISHABLE BY LAW(R.A. 8239).

_______________________________________
CALLO ___________________________________________
RAYMOND NIKKI
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
SAGARINO ________________________________________________
PHILIPPINES /DAVAO, DAVAO DEL …
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
OCTOBER / __________
16 / ___________
1987 GENDER/ KASARIAN □ MALE □ FEMALE
Month Day Year
DATE OF BIRTH/ PETSA NG KAPANGANAKAN
(Ex.: March8, 2010)

Civil Status: □ Single □ Married □ Widow/er □ Legally Separated □ Annulled


Complete Address: 229
________________________________________________________
ALUMNOS BASAK SAN NICOLAS CEBU CITY, CEBU CITY, CEBU CI… Tel. No.:____________________
+09325994489
Present Occupation:TATTOO
_______________________________________________________
ARTIST Mobile No.:_________________
+09325994489
Work Address: ____________________________________________________________
BLDG 1, UNIT 214 URBAN DECA HOMES CONDO TISA CEBU CITY Tel. No.:____________________
+09325994489
E-mail Address: CALLORAYMOND@YAHOO.COM
_______________________________________________________________________________________
Name of Wife / Husband: ADELYND
____________________________________________________
AUDREY ROSE VERALLO CALLO Citizenship:PHL
_________________
Name of Father: RAYMUNDO
___________________________________________________________
BASA CALLO Citizenship:PHL
_________________
Maiden/ Single name of Mother:JUDITH
______________________________________________
ABAY-ABAY SAGARINO Citizenship:PHL
_________________

Citizenship Acquired By:


□ Birth □ Election □ Marriage □ Naturalization □ R.A. 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: __________
(For applicants below 18 years old ONLY)
Name of minor’s travelling companion: ________________________________________________________________
Companion’s relationship: _________________________ Contact Number: __________________________________

I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application are 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)

ORGAN DONATION (Optional)


In case of death, I hereby donate [ ] Any organ / tissue [x ] Specific organ N/A
____________________ to save other people.
Please immediately notify my family at mobile / tel. no. ADELYND
___________________________.
AUDREY ROSE V. CALLO…

FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRSONLY. PLEASE DO NOT WRITE BELOWTHIS LINE.

REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer:


RECEIVEDCANCELLED PASSPORT: RECEIVEDNEWPASSPORT:
FOR ADMINISTRATIVE USE ONLY:
For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph