Important Reminders
☐ Your appointment is on 22-Aug-2025 at 08:00 - 09:00.
Please be at DFA Manila (Aseana) 15-30 minutes before your scheduled appointment.
☐ Print your application form and e-receipt on an A4-size paper for presentation and submission to your chosen
Consular Office.
☐ Be ready with both the original and photocopies of your documents to avoid delay in the processing of your
application. For reference, you may visit https://consular.dfa.gov.ph/services/passport/requirements
☐ For your civil registry documentary requirements, you may order them online from the Philippine Statistics
Authority through https://www.psaserbilis.com.ph or https://www.psahelpline.ph
☐ Passport processing fee is non-refundable and non-transferable.
☐ If you have paid for passport courier delivery online during the appointment process, your current passport
will be cancelled during your appointment.
There are no available courier delivery services at TOPS Sites. Those who applied at these sites will be unable to
request the delivery of their passports on the day of their appointment schedule.
Hindi available ang courier service sa mga TOPS Sites, dahil dito, hindi maaring mag-request sa TOPS na mai-
deliver via courier service ang inyong passport sa araw ng iyong appointment.
☐ If you have chosen to pick up your passport, you may claim your passports at the respective Supervising
Consular Office (SCO) of the TOPS where you applied. Please click HERE to check the location of the SCO.
Kung pinili ninyong i-pick up ang iyong passport, maari itong kunin sa designated na Supervising Consular office
(SCO) ng TOPS Site kung saan kayo ay nag-apply. I-click ang link na ito para makita ang listahan ng mga SCO.
☐ Note that passports for pick-up must be claimed at the designated SCO and applicants will not be able to
request for passport delivery on the day of their appointment.
Ang mga passports na for pick-up ay kinakailangang kunin sa mga designated na SCO dahil hindi maaring mag-
request ng delivery sa TOPS Site sa araw ng inyong appointment.
☐ Please be reminded that, per Department Order 2021-012, unclaimed passports after one (1) year will be
cancelled.
Mahalagang tandaan na ang mga passports na hindi nakuha ng aplikante sa loob ng isang (1) taon ay i-kakansela,
alinsunod sa Department Order No. 2021-012.
Steps at the Consular Office - Data Capturing Site
Have your appointment verified at the verification section. Present your duly accomplished application
Step 1 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.
Present your verified application form and requirements to the processor. Please note that you MAY be
Step 2 required to present other requirements.
If approved, double check that the processor has signed your form.
Proceed to the data capturing /encoding section. Make sure that all information entered is complete and
Step 3 correct before signing on the electronic confirmation page.
For Passporting on Wheels, courier services are mandatory.
Additional Reminders
Photo requirement: dress appropriately; avoid wearing heavy or theatrical make-up
A medical certificate may be required for a medical procedure done on the applicant that may interfere in the
photo or fingerprint capture process.
Applicants are also requested to accomplish the DFA Service Quality Feedback Form by scanning the
corresponding QR Code, visiting the link in the poster attached in this email, or accomplishing the included paper-
based feedback form. Your responses will help us improve our services
W.en-PH.1.1.3(1926933801.23)
DFA-OCA-PDO-02
APPOINTMENT DETAILS: REV. 02/ 27 DEC 2024
00042025082201461 Republic of the Philippines BR-010725
DFA Manila (Aseana) DEPARTMENT OF FOREI GN AFFAI RS
22-Aug-2025 PASSPORT APPLI CATI ON FORM
08:00 - 09:00
THIS APPLICATION FORM IS NOT FOR SALE. PLEASE DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE. PROVIDING
FALSE STATEMENTS IN PASSPORT APPLICATIONS IS PUNISHABLE BY LAW (R.A. 11983).
APPLICATION TYPE: ORDER OF PAYMENT: (FOR USE OF THE DFA ONLY.)
EXPEDITE REGULAR LOST / DAMAGED OTHERS
ADULT MINOR (below 18 years of age)
(250.00) (950.00) (1,300.00)
ANDALLO ROXANNE
LAST NAME / APELYIDO FIRST NAME / PANGALAN (Jr./II/III)
TADENA TAYUG, PANGASINAN
MIDDLE NAME / GITNANG PANGALAN PLACE OF BIRTH / POOK NG KAPANGANAKAN
26 JANUARY 1999 SEX /KASARIAN MALE FEMALE
DAY /MONTH /YEAR
DATE OF BIRTH /PETSA NG KAPANGANAKAN NATIONAL ID NO.
Civil Status: Single Married Widow/er Legally Separated Annulled
Present Address: 2C301 CHATEAU ELYSEE DONA SOLEDAD AVE MOONWALK, PARANAQUE, METRO MANILA
Contact no.: 639531382541 Email address: jencstone@yahoo.com
Spouse's Name: Spouse's citizenship:
Father's Name: ANDALLO, ROSMO SR BALMORES Father's citizenship: PHL
Mother's Maiden Name: TADENA, NENITA MONTORIO Mother's citizenship: PHL
Citizenship Acquired By: Birth Election Naturalization R.A. 9225 Others
Have you ever acquired foreign citizenship? Yes No Have you served in any foreign military? Yes No
If Yes, from what country? If Yes, from what country?
Mode of acquisition: Birth Naturalization Others Have you renounced your Philippine Citizenship? Yes No
Have you been issued a foreign passport? Have you ever been issued a Philippine passport? Yes No
Yes No
If Yes, latest passport number?
If Yes, from what country? Date of issue: Place of issue:
I HEREBY DECLARE AND AFFIRM that(1) I am a Filipino citizen, (2) the information I provided in this application are true and correct, (3) the supporting
documents 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.
PRIVACY POLICY: I understand that I am giving my unequivocal consent to the disclosure, collection, and use of my personal information and the data
required under the New Passport Law and its Implementing Rules and Regulations. My consent effectively constitutes a waiver of any and all privacy rights pertaining
to the disclosure, collection, and use of my personal information and data under the specific terms and condition found in the DFA Online Passport Appointment
System Website's Privacy Policy and other pertinent DFA rules, regulations, policies on the matter, including the sharing of the above information with other Philippine
Government agencies, subject to the Data Privacy Act of 2012. I authorize the DFA to publish my First and Last Name in the DFA website for the purpose of official
advisory that my passport is available for release
BY SIGNING BELOW, I acknowledge that I have carefully read this application form and fully understand its contents. I hereby voluntarily agree that if I
am unable to attend my scheduled passport appointment or if my passport application is denied due to lack of documentary requirements or other reasons, my
payment for the passport application will be forfeited and nonrefundable
Signature of Applicant or Parent / Legal Guardian (for minor applicants)
For MINOR applicants In Case of Emergency
Accompanied by: Name of Emergency Contact:
Relationship to the applicant: Mobile No: Relationship:
Mobile No. (Accompanying adult): Present Address:
FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRS ONLY. PLEASE DO NOT WRITE BELOW THIS LINE.
REMARKS: RECEIVED CANCELED PASSPORT:
WL VERIFICATION:
Verifier: Processor: Encoder:
Signing Officer: Transmission Officer:
E-Receipt No: 25500042324 For more details please visit https://consular.dfa.gov.ph/
W.en-PH.1.1.3(1926933801.23)
Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
ELECTRONIC RECEIPT NO. 25500042324
PAYMENT DETAILS:
MERCHANT: Paymaya
BRANCH CODE: maya-wallet
REFERENCE NO: 498613203536g0
DATE: 10-Aug-2025
TIME: 14:42
APPOINTMENT NUMBER: 00042025082201461
NAME: ROXANNE TADENA ANDALLO
SITE NAME: DFA Manila (Aseana)
TRANSACTION: Passport processing
PROCESSING TYPE: Special
MODE OF PAYMENT:CARD
SERVICE NUMBER: 25500042324
Passport Fee ₱950.00
AMOUNT PRF Fee ₱250.00
W.en-PH.1.1.3(1926933801.23)-RT-020725
W.en-PH.1.1.3(1926933801.23)
Republic of the Philippines
DEPARTMENT OF FOREIGN AFFAIRS
ELECTRONIC RECEIPT NO. 25500042324
PAYMENT DETAILS:
MERCHANT: Paymaya
BRANCH CODE: maya-wallet
REFERENCE NO: 498613203536g0
DATE: 10-Aug-2025
TIME: 14:42
APPOINTMENT NUMBER: 00042025082201461
NAME: ROXANNE TADENA ANDALLO
SITE NAME: DFA Manila (Aseana)
TRANSACTION: Passport processing
PROCESSING TYPE: Special
MODE OF PAYMENT:CARD
SERVICE NUMBER: 25500042324
Passport Fee ₱950.00
AMOUNT PRF Fee ₱250.00
W.en-PH.1.1.3(1926933801.23)-RT-020725
W.en-PH.1.1.3(1926933801.23)
