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PETITION
I, ____________________________________________________________________________,
[Name in Philippine Document]
also known as _______________________________________________________, _____ years of age,
[Name in foreign passport]
male/female, am single/widowed/divorced/annulled/separated/married to _________________________
(underline applicable)
_____________________________citizen by birth/election/marriage/naturalization;
[Mother’s citizenship at the time of petitioner’s birth] [at the time of petitioner’s birth (underline applicable)]
WHEREFORE, it is prayed that this petition for Attach your 2x2 colored
Retention and/or Re-acquisition of Philippine photographwith white
background using
Citizenship under Republic Act No. 9225 be permanent glue in the
GRANTED. photograph box.
The photograph must be taken
within the last three (3) months
from the date of application.
____________________________________________________ A scanned photograph is not
Signature over Printed Name allowed. A photograph of the
applicant wearing eyewear (i.e.
__________________________________________ sunglasses, colored contact lenses,
etc.) or headwear is not acceptable.
Date [DD-MMM-YYYY e.g. 01 JAN 1990]
VERIFICATION
I certify under oath that the above statements are true and correct to my own personal knowledge, and based on authentic
documents in my possession.
________________________________________
Applicant’s Signature over Printed Name
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