Important Reminders

☐ Your appointment is on Friday, Apr 12, 2019 at 10:00 - 11:00.

Please be at Tuguegarao (Reg. Gov't Center, Tuguerao City) 15-30 minutes before your
scheduled appointment.

☐
Please make sure you have prepared all the requirements.
You may refer to https://consular.dfa.gov.ph/passport
Processing fee is non-refundable and non-transferrable.

☐
Be ready with both the original and photocopies of your documents during your
appointment. Application processing may be delayed if applicants are not ready with
copies of their documents once inside the data capturing site.

☐ For your NSO/PSA

https://www.ecensus.com.ph/
Certificate requirements, you may contact

☐
Kindly print your duly accomplished application form (with barcode) and e-receipt on
A4-size paper. You must have a printed application form and e-receipt to show and
submit at your chosen application site.

Steps at the Data Capturing Site

Step 1 Have your appointment verified at the verification section.
Present your duly accomplished application form, an ID, and your e-receipt.
Please double check that the verifier has signed or stamped your form before
proceeding to the next step.

Step 2 Present your verified application form and requirements to the processor.
Please note that you MAY be required to present other requirements.
There is no 100% guarantee your application will be approved on the same day.
If approved, double check that the processor has signed your form.

Step 3 Once approved, proceed to the data capturing / encoding section. Please remove all
hair accessories, colored contact lenses, piercings on the face and ears while waiting
your turn.
When your photo has been captured and your information encoded, please double
check that all information entered is complete and correct.

Step 4 You may opt in for courier services. Please approach any of the couriers inside the
(optional) capture site.

Reminders
Please wear clothing that will cover your shoulders. Avoid wearing strapless, spaghetti-strapped, or tank
tops; halters; backless; see-through or cut-out tops; and deep necklines. Please do not wear shorts,
shorts skirts. Please wear shoes. Remember, you are entering a government office. Please dress
appropriately.
You want to look good in your passport photo, but please do not put on heavy or theatrical make-up.
This may result with you having to remove your make-up during the photo.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
Tuguegarao (Reg. Gov't DEPARTMENT OF FOREIGN AFFAIRS
Center, Tuguerao City)
Friday, Apr 12, 2019
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).

_______________________________________
POBRE ___________________________________________
MICHAEL KIT
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
TORIBIO ________________________________________________
PHILIPPINES /ILAGAN CITY
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
FEBRUARY / __________
12 / ___________
1984 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: BLOCK
________________________________________________________
6 LOT 8 SOUTH FRANCISCA VILLAGE ALIBAGU, ILAGAN, ISAB… Tel. No.:____________________
+0786240266
Present Occupation:GOVERNMENT
_______________________________________________________
EMPLOYEE Mobile No.:_________________
+639171172869

I
Work Address: ____________________________________________________________
INHS CLARAVALL STREET CITY OF ILAGAN, ISABELA Tel. No.:____________________
E-mail Address: MATTMACKENZIE0104@YAHOO.COM
_______________________________________________________________________________________
Name of Wife / Husband: MELANIE
____________________________________________________
ADVINCULA POBRE Citizenship:PHL
_________________
Name of Father: DANILO
___________________________________________________________
BALANAY POBRE Citizenship:PHL
_________________
Maiden/ Single name of Mother:ROSE
______________________________________________
GUNAYON TORIBIO 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? _______________________

P
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. MELANIE
___________________________.
A. POBRE/ +639171698…

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: 1900516992 For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph

 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900516992

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DF9HUN2RP4
DATE: 23-February-2019
TIME: 05:00:23 PM

APPOINTMENT NUMBER: 00292019041200032

NAME: MICHAEL KIT TORIBIO POBRE

TRANSACTION:
OPY
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
PASSPORT PROCESSING

FA C
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH

AMOUNT
D
SERVICE NUMBER: 1900516992
(E-PASSPORT FEE) P950.00
(EXPEDITE FEE) P 0.00
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900516992

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DF9HUN2RP4
DATE: 23-February-2019
TIME: 05:00:23 PM

APPOINTMENT NUMBER: 00292019041200032

A NT
NAME: MICHAEL KIT TORIBIO POBRE
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
TRANSACTION:

PLIC
PASSPORT PROCESSING

Y
PROCESSING TYPE: REGULAR

P
A CO P
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1900516992
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00
Important Reminders

☐ Your appointment is on Friday, Apr 12, 2019 at 10:00 - 11:00.

Please be at Tuguegarao (Reg. Gov't Center, Tuguerao City) 15-30 minutes before your
scheduled appointment.

☐
Please make sure you have prepared all the requirements.
You may refer to https://consular.dfa.gov.ph/passport
Processing fee is non-refundable and non-transferrable.

☐
Be ready with both the original and photocopies of your documents during your
appointment. Application processing may be delayed if applicants are not ready with
copies of their documents once inside the data capturing site.

☐ For your NSO/PSA

https://www.ecensus.com.ph/
Certificate requirements, you may contact

☐
Kindly print your duly accomplished application form (with barcode) and e-receipt on
A4-size paper. You must have a printed application form and e-receipt to show and
submit at your chosen application site.

Steps at the Data Capturing Site

Step 1 Have your appointment verified at the verification section.
Present your duly accomplished application form, an ID, and your e-receipt.
Please double check that the verifier has signed or stamped your form before
proceeding to the next step.

Step 2 Present your verified application form and requirements to the processor.
Please note that you MAY be required to present other requirements.
There is no 100% guarantee your application will be approved on the same day.
If approved, double check that the processor has signed your form.

Step 3 Once approved, proceed to the data capturing / encoding section. Please remove all
hair accessories, colored contact lenses, piercings on the face and ears while waiting
your turn.
When your photo has been captured and your information encoded, please double
check that all information entered is complete and correct.

Step 4 You may opt in for courier services. Please approach any of the couriers inside the
(optional) capture site.

Reminders
Please wear clothing that will cover your shoulders. Avoid wearing strapless, spaghetti-strapped, or tank
tops; halters; backless; see-through or cut-out tops; and deep necklines. Please do not wear shorts,
shorts skirts. Please wear shoes. Remember, you are entering a government office. Please dress
appropriately.
You want to look good in your passport photo, but please do not put on heavy or theatrical make-up.
This may result with you having to remove your make-up during the photo.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
Tuguegarao (Reg. Gov't DEPARTMENT OF FOREIGN AFFAIRS
Center, Tuguerao City)
Friday, Apr 12, 2019
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).

_______________________________________
POBRE ___________________________________________
MELANIE
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
ADVINCULA ________________________________________________
PHILIPPINES /ILAGAN CITY
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
DECEMBER / __________
11 / ___________
1983 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: BLOCK
________________________________________________________
6 LOT 8 SOUTH FRANCISCA VILLAGE ALIBAGU, ILAGAN, ISAB… Tel. No.:____________________
+0786240266
Present Occupation:BANK
_______________________________________________________
EMPLOYEE Mobile No.:_________________
+639171698993

I
Work Address: ____________________________________________________________
METROPOLITAN BANK & TRUST COMPANY METROBANK NV BAMBANG CUARESMA…Tel. No.:____________________
+0783920807
E-mail Address: SMILEY_MELAI082504@YAHOO.COM
_______________________________________________________________________________________
Name of Wife / Husband: MICHAEL
____________________________________________________
KIT TORIBIO POBRE Citizenship:PHL
_________________
Name of Father: DEMETRIO
___________________________________________________________
PONTEMAYOR ADVINCULA Citizenship:PHL
_________________
Maiden/ Single name of Mother:AMPARO
______________________________________________
SORIANO FLORENDO 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? _______________________

P
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. MICHAEL
___________________________.
KIT T. POBRE/ +63917…

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: 1900516957 For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph

 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900516957

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DF7TJJDW88
DATE: 23-February-2019
TIME: 04:57:23 PM

APPOINTMENT NUMBER: 00292019041200033

NAME: MELANIE ADVINCULA POBRE

TRANSACTION:
OPY
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
PASSPORT PROCESSING

FA C
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH

AMOUNT
D
SERVICE NUMBER: 1900516957
(E-PASSPORT FEE) P950.00
(EXPEDITE FEE) P 0.00
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900516957

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DF7TJJDW88
DATE: 23-February-2019
TIME: 04:57:23 PM

APPOINTMENT NUMBER: 00292019041200033

A NT
NAME: MELANIE ADVINCULA POBRE
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
TRANSACTION:

PLICPASSPORT PROCESSING

Y
PROCESSING TYPE: REGULAR

P
A CO P
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1900516957
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00
Important Reminders

☐ Your appointment is on Friday, Apr 12, 2019 at 10:00 - 11:00.

Please be at Tuguegarao (Reg. Gov't Center, Tuguerao City) 15-30 minutes before your
scheduled appointment.

☐
Please make sure you have prepared all the requirements.
You may refer to https://consular.dfa.gov.ph/passport
Processing fee is non-refundable and non-transferrable.

☐
Be ready with both the original and photocopies of your documents during your
appointment. Application processing may be delayed if applicants are not ready with
copies of their documents once inside the data capturing site.

☐ For your NSO/PSA

https://www.ecensus.com.ph/
Certificate requirements, you may contact

☐
Kindly print your duly accomplished application form (with barcode) and e-receipt on
A4-size paper. You must have a printed application form and e-receipt to show and
submit at your chosen application site.

Steps at the Data Capturing Site

Step 1 Have your appointment verified at the verification section.
Present your duly accomplished application form, an ID, and your e-receipt.
Please double check that the verifier has signed or stamped your form before
proceeding to the next step.

Step 2 Present your verified application form and requirements to the processor.
Please note that you MAY be required to present other requirements.
There is no 100% guarantee your application will be approved on the same day.
If approved, double check that the processor has signed your form.

Step 3 Once approved, proceed to the data capturing / encoding section. Please remove all
hair accessories, colored contact lenses, piercings on the face and ears while waiting
your turn.
When your photo has been captured and your information encoded, please double
check that all information entered is complete and correct.

Step 4 You may opt in for courier services. Please approach any of the couriers inside the
(optional) capture site.

Reminders
Please wear clothing that will cover your shoulders. Avoid wearing strapless, spaghetti-strapped, or tank
tops; halters; backless; see-through or cut-out tops; and deep necklines. Please do not wear shorts,
shorts skirts. Please wear shoes. Remember, you are entering a government office. Please dress
appropriately.
You want to look good in your passport photo, but please do not put on heavy or theatrical make-up.
This may result with you having to remove your make-up during the photo.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
Tuguegarao (Reg. Gov't DEPARTMENT OF FOREIGN AFFAIRS
Center, Tuguerao City)
Friday, Apr 12, 2019
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).

_______________________________________
POBRE ___________________________________________
MATT MACKENZIE
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
ADVINCULA ________________________________________________
PHILIPPINES /ILAGAN CITY
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
JANUARY / __________
04 / ___________
2006 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: BLOCK
________________________________________________________
6 LOT 8 SOUTH FRANCISCA VILLAGE ALIBAGU, ILAGAN, ISAB… Tel. No.:____________________
+0786240266
Present Occupation:STUDENT
_______________________________________________________ Mobile No.:_________________
+639171334809

I
Work Address: ____________________________________________________________ Tel. No.:____________________
E-mail Address: MATTMACKENZIE0104@YAHOO.COM
_______________________________________________________________________________________
Name of Wife / Husband: ____________________________________________________ Citizenship: _________________
Name of Father: MICHAEL
___________________________________________________________
KIT TORIBIO POBRE Citizenship:PHL
_________________
Maiden/ Single name of Mother: ______________________________________________ Citizenship:PHL
MELANIE FLORENDO ADVINCULA _________________

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? _______________________

P
Date of issue: _________________ Place of issue: __________
(For applicants below 18 years old ONLY)
MICHAEL KIT T. POBRE
Name of minor’s travelling companion: ________________________________________________________________
Companion’s relationship: _________________________ Contact Number: +639171172869
FATHER __________________________________

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. MICHAEL
___________________________.
KIT T. POBRE/ +63917…

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: 1900517019 For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph

 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900517019

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DFM5J95EO2
DATE: 23-February-2019
TIME: 05:03:23 PM

APPOINTMENT NUMBER: 00292019041200034

NAME: MATT MACKENZIE ADVINCULA POBRE

TRANSACTION:
OPY
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
PASSPORT PROCESSING

FA C
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH

AMOUNT
D
SERVICE NUMBER: 1900517019
(E-PASSPORT FEE) P950.00
(EXPEDITE FEE) P 0.00
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900517019

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DFM5J95EO2
DATE: 23-February-2019
TIME: 05:03:23 PM

APPOINTMENT NUMBER: 00292019041200034

A NT
NAME: MATT MACKENZIE ADVINCULA POBRE
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
TRANSACTION:

PLICPASSPORT PROCESSING

Y
PROCESSING TYPE: REGULAR

P
A CO P
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1900517019
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00
Important Reminders

☐ Your appointment is on Friday, Apr 12, 2019 at 10:00 - 11:00.

Please be at Tuguegarao (Reg. Gov't Center, Tuguerao City) 15-30 minutes before your
scheduled appointment.

☐
Please make sure you have prepared all the requirements.
You may refer to https://consular.dfa.gov.ph/passport
Processing fee is non-refundable and non-transferrable.

☐
Be ready with both the original and photocopies of your documents during your
appointment. Application processing may be delayed if applicants are not ready with
copies of their documents once inside the data capturing site.

☐ For your NSO/PSA

https://www.ecensus.com.ph/
Certificate requirements, you may contact

☐
Kindly print your duly accomplished application form (with barcode) and e-receipt on
A4-size paper. You must have a printed application form and e-receipt to show and
submit at your chosen application site.

Steps at the Data Capturing Site

Step 1 Have your appointment verified at the verification section.
Present your duly accomplished application form, an ID, and your e-receipt.
Please double check that the verifier has signed or stamped your form before
proceeding to the next step.

Step 2 Present your verified application form and requirements to the processor.
Please note that you MAY be required to present other requirements.
There is no 100% guarantee your application will be approved on the same day.
If approved, double check that the processor has signed your form.

Step 3 Once approved, proceed to the data capturing / encoding section. Please remove all
hair accessories, colored contact lenses, piercings on the face and ears while waiting
your turn.
When your photo has been captured and your information encoded, please double
check that all information entered is complete and correct.

Step 4 You may opt in for courier services. Please approach any of the couriers inside the
(optional) capture site.

Reminders
Please wear clothing that will cover your shoulders. Avoid wearing strapless, spaghetti-strapped, or tank
tops; halters; backless; see-through or cut-out tops; and deep necklines. Please do not wear shorts,
shorts skirts. Please wear shoes. Remember, you are entering a government office. Please dress
appropriately.
You want to look good in your passport photo, but please do not put on heavy or theatrical make-up.
This may result with you having to remove your make-up during the photo.
APPOINTMENT DETAILS: Republic of the Philippines WCS-RRR-LVJZ-PPT-DORev. October2015
Tuguegarao (Reg. Gov't DEPARTMENT OF FOREIGN AFFAIRS
Center, Tuguerao City)
Friday, Apr 12, 2019
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).

_______________________________________
POBRE ___________________________________________
MATTEA MIKYLA
LAST NAME/ APELYIDO FIRST NAME/ PANGALAN (Jr./II/III)
____________________________________________
ADVINCULA ________________________________________________
PHILIPPINES /ILAGAN CITY
MIDDLE NAME/ GITNANG PANGALAN PLACE OF BIRTH/ POOK NG KAPANGANAKAN

____________________
DECEMBER / __________
07 / ___________
2009 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: BLOCK
________________________________________________________
6 LOT 8 SOUTH FRANCISCA VILLAGE ALIBAGU, ILAGAN, ISAB… Tel. No.:____________________
+0786240266
Present Occupation:STUDENT
_______________________________________________________ Mobile No.:_________________
+639171548609

I
Work Address: ____________________________________________________________ Tel. No.:____________________
E-mail Address: SMILEY_MELAI082504@YAHOO.COM
_______________________________________________________________________________________
Name of Wife / Husband: ____________________________________________________ Citizenship: _________________
Name of Father: MICHAE
___________________________________________________________
KIT TORIBIO POBRE Citizenship:PHL
_________________
Maiden/ Single name of Mother:MELANIE
______________________________________________
FLORENDO ADVINCULA 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? _______________________

P
Date of issue: _________________ Place of issue: __________
(For applicants below 18 years old ONLY)
MICHAEL KIT T. POBRE
Name of minor’s travelling companion: ________________________________________________________________
Companion’s relationship: _________________________ Contact Number: +639171172869
FATHER __________________________________

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. MICHAEL
___________________________.
KIT T. POBRE/ +63917…

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: 1900517045 For moredetailsplease visit www.dfa.gov.phor www.passport.gov.ph

 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900517045

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DFTR8EIZN2
DATE: 23-February-2019
TIME: 05:05:23 PM

APPOINTMENT NUMBER: 00292019041200035

NAME: MATTEA MIKYLA ADVINCULA POBRE

TRANSACTION:
OPY
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
PASSPORT PROCESSING

FA C
PROCESSING TYPE: REGULAR
MODE OF PAYMENT: CASH

AMOUNT
D
SERVICE NUMBER: 1900517045
(E-PASSPORT FEE) P950.00
(EXPEDITE FEE) P 0.00
 Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. 1900517045

PAYMENT DETAILS:
MERCHANT: BAYD
BRANCH CODE: 3309
REFERENCE NO: DFTR8EIZN2
DATE: 23-February-2019
TIME: 05:05:23 PM

APPOINTMENT NUMBER: 00292019041200035

A NT
NAME: MATTEA MIKYLA ADVINCULA POBRE
SITE NAME: TUGUEGARAO (REG. GOV'T CENTER, TUGUERAO CITY)
TRANSACTION:

PLICPASSPORT PROCESSING

Y
PROCESSING TYPE: REGULAR

P
A CO P
MODE OF PAYMENT: CASH
SERVICE NUMBER: 1900517045
(E-PASSPORT FEE) P950.00
AMOUNT
(EXPEDITE FEE) P 0.00