Docstoc

MACHINE READABLE PASSPORT

Document Sample
MACHINE READABLE PASSPORT Powered By Docstoc
					                         DATA ENCODING SHEET FOR THE
               MACHINE READABLE PASSPORT (MRP) APPLICATION FORM
REQUIREMENTS: Original & photocopy of current passport, 3 passport photos with royal blue background
PLEASE PRINT IN CAPITAL / BLOCK LETTERS

1.      SURNAME           _______________________________________________

2.      GIVEN NAME        _______________________________________________

3.      MIDDLE NAME: _______________________________________________

4.      SEX:              MALE________                       FEMALE_________

5.      DATE OF BIRTH:             DAY ________       MONTH _________________       YEAR ___________

6.      PLACE OF BIRTH:
        MUNICIPALITY / CITY:       _____________________
        PROVINCE:                  _____________________
        COUNTRY:                   _____________________

7.      ADDRESS:      House No. / Street / Village, Area / Town, City / Province, State/ Country
        ________________________________________________________________________________

8.      CIVIL STATUS:
        SINGLE _______             MARRIED_______            DIVORCED_______         WIDOWED__________

8a.     IF MARRIED, NAME OF SPOUSE
        _______________________________________________________

9a.     NAME OF APPLICANT’S FATHER
        _______________________________________________________
9b.     FATHER’S CITIZENSHIP AT TIME OF APPLICANT’S BIRTH
        _______________________________________________________
10a     MAIDEN NAME OF APPLICANT’S MOTHER
        _______________________________________________________
10b     MOTHER’S CITIZENSHIP AT TIME OF APPLICANT’S BIRTH
        _______________________________________________________

11      TYPE OF APPLICATION
        RENEWAL_______       NEW_______   REPLACEMENT FOR LOST PASSPORT______________
11a     PREVIOUS PASSPORT NUMBER: _____________________
11b     PREVIOUS DATE OF ISSUANCE: _____________________
11c     PREVIOUS PLACE OF ISSUANCE:_____________________

12      ACQUISITION OF CITIZENSHIP
        BIRTH_____ ELECTION ______ MARRIAGE______ NATURALIZATION _____ RA 9225 (Dual)_______

13      OCCUPATION :          ____________________________________________
14.     WORK ADDRESS:         ____________________________________________
15.     CONTACT INFORMATION IN INDONESIA Landline: ________________________________
        Mobile ___________________________ E-mail: __________________________________
16.     PURPOSE OF TRAVEL
        TOURISM________       BUSINESS________      IMMIGRANT_______      STUDY _______
        OFFICIAL_______       CONTRACT WORKER______        SEAMAN___________
17.     DATE OF APPLICATION:         Day___         Month__________       Year ______


       Signature of Applicant:    _____________________________________________
=========================================================================================
For Consulate-General use only:
18.      REQUESTED PASSPORT: Regular, Validity 5 years
19.      FINGER TO BE USED, IF THUMB NOT POSSIBLE
         Left     Index _____ Middle _____ Ring ____ Little ____ Null _______
         Right:   Index _____ Middle _____ Ring ____ Little ____ Null _______
20.      ISSUING AUTHORITY         PHILIPPINE CONSULATE-GENERAL, Manado
21.      PROCESSOR / ENCODER:               _________________


        RECEIVING CLERK:______________________               SIGNING OFFICER: ________________________

				
DOCUMENT INFO