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ROB 22Nov2024 

Please prepare and bring four (4) copies of this form to the Embassy with the other documentary requirements.

Kindly leave blank the following:

  • upper right official use only section
  • item number 20, date and place of signature
  • item numbers 21 to 22.

The form has three main parts:

(1) details about the child,

(2) details of the birth parents with father's details on the left, and 

(3) mother's details on the right.

Items 1-3: For married parents, kindly enter the child's name:

  1. Surname of the child's father;
  2. Child's given name/names
  3. Mother's maiden surname

Item 4: Kommune or City, Country

Item 5, 13 and 18: Date format should be written as follows:

Day Month Year

(1 January 2000). Always spell out the month

Item 7: Indicate whether single, twins or triplets, etc.

Item 8: Birth order of the child, counting all children born by mother, including fetal death

Items 9-11: Under the wife’s maiden information, kindly enter your name when you were still single, as written in your birth certificate.

Item 14: The husband’s/wife’s place of birth should be the same as written in the Philippine passport.

Item 16: Kindly leave blank if you were born with Filipino parent/s. Answer only if you are a naturalized Filipino.

Item 19: Indicate the place of marriage in the PSA Marriage Certificate or ROM

Item 20: You may type your printed name and relationship to the child but do not sign yet. Please leave blank the date and place.