APPLICATION FOR CITIZENSHIP RETENTION AND RE-ACQUISITION AND ISSUANCE OF IDENTIFICATION CERTIFICATE under REPUBLIC ACT NO. 9225 REQUIREMENTS:  Duly accomplished application form, with one photocopy  Original and photocopy of Birth Certificate in National Statistics Office (NSO) Security Paper  Original and photocopy of Marriage Certificate (for married female applicant)  Three (3) recent passport-size photographs (colored with ROYAL BLUE background)  Fee of €50 per applicant (for applications by mail, payment shall be in the form of Mandat Cash payable to Ambassade des Philippines) and additional fee for Derivative Citizenship for qualified dependents (see below)  Original and photocopy (data page) of foreign passport  Original and photocopy (back and front) of Identity Card (Carte d’Identité)  Original and photocopy of Certificate of Naturalization or other documents to prove naturalization in a foreign country  Original and photocopy (data page and last page) of recent Philippine passport  French and Portuguese documents should have official English translations DEPENDENTS FOR DERIVATIVE CITIZENSHIP  Original and photocopy of foreign passport  Original and photocopy of Birth Certificate (or Acte de Naissance Copie Integrale for those born in France)  One (1) recent passport-size photograph (colored with ROYAL BLUE background) for each qualified dependent  Fee of €25 for each qualified dependent child BI-REGISTERED APPLICANTS  Original and photocopy of Alien Certificate of Registration (ACR)  Original and photocopy of Immigrant Certificate of Residence (ICR) or Certificate of Residence for Temporary Visitors (CRTV) INSTRUCTIONS  Application form must be duly accomplished, signed, and photocopied. Incomplete information on the application form may cause delay/inaction in the processing of application.  All requirements should be submitted with the duly accomplished application form. All your original documents will be returned to you as soon as verified by the processor.  If the documents are complete and satisfactory, the applicant will be informed of the schedule for taking the Oath of Allegiance, in which personal appearance is required.  After taking your Oath, you will be given the original Order approving your application, your Identification Certificate, and your signed Oath of Allegiance. As you will be given only one copy, it is advised that you keep these documents safely.  Passport applications are processed and paid for separately and may take one to two months to issue.

EMBASSY OF THE PHILIPPINES 4 Hameau de Boulainvilliers 75016 Paris, France

Tel No. +331.44.14.57.00 Fax No. +331.44.14.57.03 E-mail: [email protected]

VERIFIED PETITION FOR CITIZENSHIP RETENTION AND RE-ACQUISITION AND ISSUANCE OF IDENTIFICATION CERTIFICATE under REPUBLIC ACT NO. 9225 Passport-size photo

Passport-size photo

ROYAL BLUE background taken within the last six (6) months, without eyeglasses, clearly showing the full front view of the face of the applicant

ROYAL BLUE background taken within the last six (6) months, without eyeglasses, clearly showing the full front view of the face of the applicant

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Before accomplishing this Form, please read carefully and follow the instructions. Print all information legibly and avoid erasures. Do not leave any space blank. Indicate “N/A” if not applicable. Mark appropriate boxes with an X.

I, ____________________________________, of legal age, a/an ________________________citizen and a resident of __________________________________________________________, after having been duly sworn to in accordance with law, hereby declare under oath the following: I. PERSONAL INFORMATION: Date of Birth (dd-mm-yyyy): __________________________ 3. Place of Birth: ______________________________ Civil Status:

5. Gender: Single Married Male Widow/er Divorced Female Others Present Occupation : __________________________________________________________________________________ Complete Address in the Philippines: (house no., street, town or city, zip code) ___________________________________ ______________________________________________________________________________________________ Complete Mailing Address : ____________________________________________________________________________ Home Telephone No: _________________________________ Work/Mobile Phone No: ___________________________ E-mail Address/Fax No: ________________________________________________________________________________ Name of Spouse : __________________________________________ Nationality of Spouse ________________________ Name of Applicant’s Father: _____________________________________ Birthdate (dd-mm-yyyy): __________________ Father’s Citizenship at the time of applicant’s birth: __________________________________________________________ Name of Applicant’s Mother: ____________________________________ Birthdate (dd-mm-yyyy): ___________________ Mother’s Citizenship at the time of applicant’s birth: _________________________________________________________

I am a former natural-born Philippine Citizen and the following is my current immigration status: II. IMMIGRATION STATUS Current Foreign Citizenship : ____________________________________________________________________________ Mode of Acquisition of Foreign Citizenship : ________________________________________________________________ Date of Acquisition of Foreign Citizenship: _________________________________________________________________ Foreign Passport No.: __________________________________________________________________________________ Place Issued : _____________________________________ Date Issued (dd-mm-yyyy): ___________________________ Previous Philippine Passport no.: _________________________________________________________________________ Place of Issue :_____________________________________ Date of Issue (dd-mm-yyyy):__________________________

III. DERIVATIVE CITIZNSHIP NAME, PLACE AND DATE OF BIRTH OF UNMARRIED CHILDREN BELOW 18 INCLUDED AS DEPENDENTS IN THIS PETITION: Name 1 ________________________________ 2 ________________________________

Place of Birth ______________________________ ______________________________

Date of Birth _____________________ _____________________

3 ________________________________ 4 ________________________________

______________________________ ______________________________

_____________________ _____________________

One Passport-size photo

One Passport-size photo

One Passport-size photo

One Passport-size photo

ROYAL BLUE background taken within last six (6) months, without eyeglasses, clearly showing the full front view of the face of dependent child no. 1

ROYAL BLUE background taken within last six (6) months, without eyeglasses, clearly showing the full front view of the face of dependent child no. 2

ROYAL BLUE background taken within last six (6) months, without eyeglasses, clearly showing the full front view of the face of dependent child no. 3

ROYAL BLUE background taken within last six (6) months, without eyeglasses, clearly showing the full front view of the face of dependent child no. 4

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Name:

Name:

Name:

Name:

I am freely and voluntarily filing this petition to re-acquire/retain my Philippine Citizenship, knowing fully well its concomitant rights and obligations. This Petition with the Bureau is being filed in accordance with Republic Act No. 9225 and its implementing rules and regulations.

CERTIFICATION I hereby certify under oath that all the information in this general application form composing of two pages including the page on which this Certification is written are true and correct information about myself as an applicant. I further warrant that I have complied with all the requirements with respect to my application and that I submitted duly certified copies of documents issued under the official seal of the officer having legal custody of their originals in the Philippines and foreign documents duly authenticated by the consular/embassy official in the foreign service of the Philippines in the foreign country, in compliance with the requirements of the Bureau of Immigration. I understand that my application will not be processed by the Bureau if it finds any statement herein to be false, if any document submitted is found to have been falsified, or if I fail to comply with any of the requirements of the Bureau of Immigration with respect to my application / petition without prejudice to whatever action (s) the Bureau of Immigration shall take in accordance with applicable laws of the Republic of the Philippines. Date executed : ______________________________ Place executed : _____________________________

__________________________________________ (Applicant’s Signature over Printed Name)