Important Reminders

☐
Your appointment is on Saturday, Apr 28, 2018 at 08:00 - 09:00.
Please be at DFA Manila (Aseana) 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
DFA Manila (Aseana) DEPARTMENT OF FOREIGN AFFAIRS
Saturday, Apr 28, 2018
08:00 - 09:00 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).

_______________________________________
TSANG ___________________________________________
PATRICK
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
SANTIAGO ________________________________________________
PHILIPPINES /MANILA
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
DECEMBER / __________
09 / ___________
1996 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

D
Complete Address: UNIT
________________________________________________________
A2902 ALPHA GRANDVIEW CONDOMINIUM, 1716 M.H. DEL PILAR… Tel. No.:____________________
Present Occupation:NONE
_______________________________________________________ Mobile No.:_________________
+09062131458

I
Work Address: ____________________________________________________________ Tel. No.:____________________
E-mail Address: SECHICODR@GMAIL.COM
_______________________________________________________________________________________
Name of Wife / Husband: ____________________________________________________ Citizenship: _________________
Name of Father: WA
___________________________________________________________
LEUNG TSANG Citizenship:GBO
_________________
Maiden/ Single name of Mother:JOCELYN
______________________________________________
BAISAC SANTIAGO Citizenship:PHL
_________________

A
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? _______________________
EB8895149

P
Date of issue: _________________
08-12-2013 Place of issue: DFA
__________
MANILA
(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. JOCELYN
___________________________.
S TSANG/ +0915371711…

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:

E-Receipt No: 0000010115 For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph

 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 0000010115

PAYMENT DETAILS:
LOCATION: ECPAY
DATE: 25-April-2018
TIME: 05:50:25 PM

TRANSACTION: PASSPORT PROCESSING

AMOUNT: P 1200.00
PROCESSING TYPE: EXPRESS
MODE OF PAYMENT: CASH
SITE NAME: DFA MANILA (ASEANA)
ORDER OF PAYMENT: 2018010031

APPOINTMENT REFERENCE NO. APPLICANT NAME

00042018042800346 PATRICK TSANG

DFA Copy
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 0000010115

PAYMENT DETAILS:
LOCATION: ECPAY
DATE: 25-April-2018
TIME: 05:50:25 PM

TRANSACTION: PASSPORT PROCESSING

AMOUNT: P 1200.00
PROCESSING TYPE: EXPRESS
MODE OF PAYMENT: CASH
SITE NAME: DFA MANILA (ASEANA)
ORDER OF PAYMENT: 2018010031

APPOINTMENT REFERENCE NO. APPLICANT NAME

00042018042800346 PATRICK TSANG

Applicant Copy