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Leonor Mendeja is applying for an e-passport from the Philippines. She provides her personal details including her name, date and place of birth, gender, citizenship, address, occupation, contact details, parents' names, and purpose of travel. She affirms that the information and supporting documents provided are true and correct, and that she is aware making false statements is punishable by law.

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Martial Mendeja
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66 views

Print

Leonor Mendeja is applying for an e-passport from the Philippines. She provides her personal details including her name, date and place of birth, gender, citizenship, address, occupation, contact details, parents' names, and purpose of travel. She affirms that the information and supporting documents provided are true and correct, and that she is aware making false statements is punishable by law.

Uploaded by

Martial Mendeja
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FOREIGN AFFAIRS


MANILA
E-PASSPORT APPLICATION

PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK

MENDEJA LEONOR
LAST NAME / APELYIDO FIRST NAME / PANGALAN (Jr. / II / III)

AGONCILLO BOAC MARINDUQUE


MIDDLE NAME / GITNANG PANGALAN PLACE OF BIRTH / POOK NG KAPANGANAKAN

MAY 09, 1977 FEMALE


DATE OF BIRTH (Ex. Day/Month/Year) GENDER / KASARIAN
Civil Status: ☐
X Single ☐ Married ☐ Widow/er ☐ Legally Separated ☐ Annulled
Name of Wife / Husband: Citizenship:
Complete Address: Tel. No:
Present Occupation: Mobile No: 09185039302
Work Address:
Email Address: [email protected] Office No:
Name of Father: ARCADIO NAZARENO MENDEJA Citizenship:
Maiden/Single Name of
BEATRIZ MAMITAG AGONCILLO Citizenship:
Mother:

Citizenship Acquired By: Purpose of Travel:


☐ Birth ☐ Election ☐ Marriage ☐ Naturalization ☐ Tour ☐ Seaman ☐ Business ☐ Migration
☐ R.A.9225 ☐ Others: ________________________ ☐ Study ☐ Work ☐ Others: ______________

Are you a holder of a foreign passport? Have you ever been issued a Philippine Passport?
☐ Yes ☐ No ☐ Yes ☐X No
If Yes, from what country? ___________________ If Yes, latest passport number? _______________

Date of issue ________ Place of issue _________

This serves as Affidavit of Support and Consent to Travel This serves as Affidavit of Loss
(for Applicants below 18 years old ONLY) Lost Passport Number:
Name of minor's Issued on:
traveling companion:
Issued by:
Companion's
Relationship: Date lost:
Address / Contact Lost due to:
Number:

Signature of Parent or Legal Guardian Signature of Applicant


I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application is true and correct. 3) The supporting
documents attached are authentic. 4) I have not been issued a passport under any other name. 5) I am aware that under the law, I am
allowed to hold only one Philippine passport at any given time. 6) 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
REMARKS:

FOR STRICT COMPLIANCE: Please print name and affix initials.

Processor: Encoder: Signing Officer:


RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:

FOR ADMINISTRATIVE USE ONLY:

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