BI FORM 2014-01-005 Rev 0 This document may be reproduced and is NOT FOR SALE

PETITION FORM FOR RETENTION/RE-ACQUISITION OF

PHILIPPINE CITIZENSHIP UNDER R.A. 9225

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)

____________________________. I, a citizen of _________________and resident of _______________

____________________________________________ with contact number ______________________,
after being sworn to in accordance with law, hereby declare under oath that:
1. I am a former natural-born Philippine citizen, born on ___________________________________
[DD-MMM-YYYY e.g. 01 JAN 1990]
at ___________________________to _______________________________________________,
[as appearing in Philippine document] [Father’s name]
_______________________________citizen by birth/election/marriage/naturalization, who was
[Father’s citizenship at the time of petitioner’s] birth [at the time of the petitioner’s birth(underline applicable)]

married/not married to ___________________________________________________________,

[Mother’s name]

_____________________________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)]

2. I lost my Philippine citizenship when I became a citizen of ________________________________

on _____________________. Presently, I am a holder of a valid ___________________ passport
with number _________________ issued on ___________________ at ____________________;
[DD-MMM-YYYY e.g. 01 JAN 1990]
3. I took my Oath of Allegiance to the Republic of the Philippines on __________________________
[DD-MMM-YYYY e.g. 01 JAN 1990]
at _______________________________;
(If the petitioner is a registered alien with the Bureau of Immigration):
4. I surrender for cancellation my original Alien Certificate of Registration (ACR)
no. _______________________and/or Immigrant Certificate of Residence/Certificate of Residence
for Temporary Visitors (ICR/CRTV) no. _________________________;
(If with Dependent/s):
5. Included in this petition is/are my unmarried child/ren below eighteen (18) years of age, namely:
Name Gender Date of Birth Age
[DD-MMM-YYYY e.g. 01 JAN 1990]
_______________________________________ _______ ________________________ _____
_______________________________________ _______ ________________________ _____
_______________________________________ _______ ________________________ _____
(Please use BI Form 2014-01-006 Rev 0 for each dependent to be attached to this petition.)

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

SUBSCRIBED AND SWORN TO before me this ______________ in _______________________, Petitioner personally

appeared and exhibited to me his/her passport with number _____________________ issued on ____________________________
at __________________.
Doc No.: _________
Page No.: ________
Book No.: ________
Series of ________

Page 1 of 1