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Thank you! You have successfully reserved an appointment with Philippine Embassy - Korea Please take note of your reserved appointment: Name: veloria, mario jaime

Purpose of Appointment: Passport Renewal Date of Appointment: Time of Appointment: Confirmation Code: Reminders:
Print this confirmation stub and present it during your scheduled appointment, along with your old passport (make a copy of the first and last pages, together with the page showing your date of last entry) and other documents. For a complete list of the requirements and procedures upon arrival at the Philippine Embassy, please visit the section on Consular Services. You can also print and complete the prepared application form below so you do not have to accomplish the same form at the window. Failure to show up at your scheduled appointment automatically cancels the reservation. You need to make a new appointment and choose another date. To cancel a reservation appointment, go to the "Cancel Reservation Page" and enter your confirmation code. Cancelled appointments can not be re-activated.

Sunday, February 19, 2012 9:00 AM 20229

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REPUBLIC OF THE PHILIPPINES EMBASSY OF THE REPUBLIC OF THE PHILIPPINES SEOUL, KOREA E-PASSPORT APPLICATION

PLEASE PROVIDE CORRECT INFORMATION AND DO NOT LEAVE SPACES BLANK.

NOT FOR SALE

VELORIA
LAST NAME / APELYIDO

February-26-1986
DATE OF BIRTH (Ex. 01-Jan-2000)

MARIO
FIRST NAME / PANGALAN (Jr. / II / III)

BANI, PANGASINAN
PLACE OF BIRTH / POOK NG KAPANGANAKAN

JAIME
MIDDLE NAME / GITNANG PANGALAN

GENDER / KASARIAN:

MALE

Maiden or Single Name of Wife / Name of Husband (if applicable) Civil Status: (Last Name / First Name / Middle Name) Address in Korea:

1502-1 SAHAGU DADAE-DONG BUSAN CITY, GYEONGSANG-DO


Tel. No.: Mobile No.:

Present Occupation: E-mail Address:

010-72195431

djmario85@yahoo.com 31 DON JUAN OBOZA ST POB. BANI PANGASINAN

Address in Philippines:

Tel. No.: Citizenship:

Name of Father: (Last Name / First Name / Middle Name) Maiden / Single Name of Mother: (Last Name / First Name / Middle Name) Citizenship acquired by: If Others, pls. specify: Are you a holder of a foreign passport? Yes If Yes ,from what country? No Purpose of Travel: If Others, pls. specify:

Citizenship:

Have you ever been issued a Philippine Passport? Yes Date of Issue:
August-7-2007

No

If Yes ,latest Passport Number:

WW-0021614

Place of Issue:
department of foreign affairs manila

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 passort at any given name. 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
RECIEVED CANCELLED PASSPORT: FOR ADMINISTRATIVE USE ONLY:

Encoder

Signing Officer
RECIEVED NEW PASSPORT:

For inquiries, please call (02) 796-7387 to 89 or visit http://www.philembassy-seoul.com