PIO FomNa.
Revision No) (Dat)
Appian Conta Na:
‘Acetng Po fice ade
‘cep ost fice Nae
Ono Taba:
PHLPOST SS. punscome 06st esis satis
APPLICATION FOR POSTAL ID CARD
RASNAD HE CEAL TINE DCAD oe
ALLFIELDS WITH (~~ ) ARE REQUIREDss om rr ; "
PARTI -TO BE FILLED OUT BY THE APPLICANT
EW batas
PURPOSE CARDTYPE DELIVERY |CLCARD REPLACEMENT
Ceme [eae | Once | rag Fomine
C1 fenewat DO Prexuns Claus ] Amendment of Blogaphic Data others
B. APPLICANT DETAILS
Srennee nares ee en
“GENDER 7 GATE BURTH (MM7DB/¥PYY) 7 PLACE OF BIRTH (CTY/MUNICIPALITY SW TROVINCE) 7 Ton
A) ee |e] ale epee ene jee il
=
NAOMI ppeuraion banal single D Marg Widowed Cseparated Cdivorced/znnuiied
| l | | ee (eel ES | |
corsa rates wala
{| | 1 |_| {11/11 11 1 | L l |
essa
PREFERRED MAILING ADDRESS (cvoose one PRESENT WwoRK
(GFT
(steer nae
anacTOITRIETABALIT
LititJilitittity tt Lititititi tigi tii tit
(arvvwaraury) aor oun yrost one
Meee
(CONPARVRAFATUNITNO/ BLOG. RANE) (HOUSE LTE BLK) (steer nae
ett PIII | L I1iti11Ititt
‘Gusonson anaicRoISTRIETBCALTY
Lititjilitittitj it Litititttiipittitit
(arvana) PHONG out (Post obey
Eee
ENGERPRINTS IF APPLICANT CANNOT IG
‘Notwithstanding the confident ofthe dt that have spleen nee ie
‘the urpoes content wth th objec ofthc emer. rte a ty
“fang my spate on ths form a tenants appeanng nts fxm and on he
ty Postale eine .
[APPLICANT'S SIGNATURE NS WITNEss’siGNATURE
SIGNATURE OVER PRINTED NAME ATE SIGNATURE OVER PRINTED NAME
PART Il-TO BE FILLED OUT BY PHLPOST
‘SUPPORTING DOCUMENTS PRESENTED: ‘APPROVED BY:
Lnsosinncercae 1D xangay cette
Dotter 'HGHATURE OVER PRINTED NAME DAE
en carton scout DATA CAPTURED BY
SCREENED By Capturing Pst fice ame Cote
SIGNATURE OVER PAINTED NAME DATE | Date/Time —SINATURE OVER PAINTED NAME DATE
TEAR HERE =~
iepulblic oF the Bhilippines |” picaun nto
PHLPOSTS. PHILIPPINE POSTAL CORPORATION | jet
APPLICATION FOR POSTALIDCARD) 3".
ACKNOWLEDGEMENT SLIP ( CLIENT COPY )
FORALREFEENCENGTe im GAN” RANE pa rors warn a
‘APPROVED BY ‘DATA CAPTURE SCHEDULE DATA CAPTURED BY
Capturing Pst Ofc Name Cote
SIGNATURE OVERPRINTED NAME DATE Date Tie SIGNATURE OVER PRINTED NAME DATE
For inquiries, Please CallCustomer Service Hotline 5275409