ARMED FORCES OF THE PHILIPPINES
ID APPLICATION FORM
DEPENDENT
ACTIVE OFFICER: ACTIVE ENLISTED PERSONNEL: REQUIREMENTS
1. Duly accomplished application form
FIRSTNAME: and endorsed by their admin officer.
2. Spouse – PSA marriage contract and
MIDDLE NAME: birth certificate.
Children – (Not over 21 years old) PSA
birth certificate
Parents – (Indigent parents 60 years of
LAST NAME: age and above) birth certificate of active
personnel and applicant issued by PSA
HOME ADDRESS: 3. Surrender old AFPIC, if lost attached
affidavit of loss and police blotter.
WEIGHT: kgs. HEIGHT: cms. BLOOD TYPE:
SINGLE MARRIED
EYES: HAIR: CIVIL STATUS WIDOW DIVORCE PASTE
TIN: GENDER: Recent 2x2 colored picture
In formal / semi formal
attire w/ white background
DATE OF BIRTH (DD-MMM-YYYY): no mustache / beard,
eye glasses
NAME OF PARENTS FATHER’S NAME MOTHER’S MAIDEN NAME in proper haircut.
FIRST NAME:
MIDDLE NAME:
LAST NAME:
FIRST NAME:
MILITARY PERSONNEL DATA
MIDDLE NAME:
LAST NAME:
RANK: BRANCH OF SERVICE:
AFPSN: RELATIONSHIP TO THE APPLICANT:
UNIT ASSIGNMENT:
ADDRESS:
KEEP SIGNATURE INSIDE THE BOX
CONTACT NO. OF PERSON (Signature must be visible)
TO BE NOTIFIED:
PERSONAL CONTACT NUMBER:
CAD / ETAD / SOT / ETE (DD-MMM-YYYY):
RIGHT THUMBMARK
Statement of Consent
I declare that I am fully aware that the above data shall be used for securing my Common Reference Number (CRN) for
Unified Multi-Purpose ID (UMID) system for updating my personal data and that I shall form part of the CRN registry. I trust
that the above data shall remain confidential hence I give my consent that the same data be secured and accessed for
subsequent validation, verification and other purposes consistent with the objectives of the UM-ID System are true and
complete to the best of my knowledge and belief.
__________________________ ____________________________________
DATE SIGNED SIGNATURE OVER PRINTED NAME
ENDORSED BY: _________________________ APPROVED BY: __________________________ PROCESSED BY: _____________
REMARKS
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
_________________________________ ___________________________________ VERIFIED BY: ________________
RANK BR OF SVC TAG, AFP / MAJ SVC AD J
RECORDED BY: ______________
_________________________________
UNIT ADJ / ADMIN OFFICER
ID no.: ______________________ DATE: ___________ ID no.: ______________________ DATE: ___________
Firstname / Lastname Firstname / Lastname
1. Paid the amount of ONE HUNDRED PESOS (Php100.00) for PAFIC 1. Paid the amount of ONE HUNDRED PESOS (Php100.00) for PAFIC
2. Please present this when claiming your PAFIC on _________ 2. Please present this when claiming your PAFIC on _________
_____________________________ _____________________________
Applicant’s Signature Applicant’s Signature
CLAIM STUB COPY
