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Birth Certificate Application Form

This document is an application form for requesting a birth certificate from the National Statistics Office of the Philippines. It requests information such as the applicant's name, date of birth, place of birth, parents' names, number of copies needed, and purpose of the request. It notes that a valid ID is required for both the document owner and requester. It also specifies that authorization is needed if the requester is not the owner, parent, spouse, descendant, or legal guardian. The applicant must sign to acknowledge they understand the authorization requirements under Philippine law.

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Mikee Sagada Marbacias
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102 views2 pages

Birth Certificate Application Form

This document is an application form for requesting a birth certificate from the National Statistics Office of the Philippines. It requests information such as the applicant's name, date of birth, place of birth, parents' names, number of copies needed, and purpose of the request. It notes that a valid ID is required for both the document owner and requester. It also specifies that authorization is needed if the requester is not the owner, parent, spouse, descendant, or legal guardian. The applicant must sign to acknowledge they understand the authorization requirements under Philippine law.

Uploaded by

Mikee Sagada Marbacias
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DATE

THIS FORM IS NOT FOR SALE


Republic of the Philippines
National Statistics Office
OFFICE OF THE CIVIL REGISTRAR GENERAL
APPLICATION FORM - BIRTH CERTIFICATE
IMPORTANT : PLEASE READ GENERAL INSTRUCTIONS BEFORE FILLING UP THE FORM
General 1. Please PRINT letters in the spaces provided. Please CHECK (a) appropriate box(es).
Instructions : 2. A valid ID is required for both owner & requester of document.
Instructions: 3. An authorization is required from representative's upon filing of the application.

Request for : BIRTH CERTIFICATE AUTHENTICATION BIRTH CARD CDLI

Number of copies ? One Two Others (Specify) : __________


Sex: Male
Birth Reference No. - - -
BReN (if known) Female

OWNER'S PERSONAL INFORMATION (For married women, please use maiden name)
Last Name þ ÿ
First Name þ ÿ
Middle Name þ ÿ
Date of Birth þ ÿ þ ÿ þ ÿ
MONTH DAY YEAR

Place of Birth þ ÿ
City / Municipality
þ ÿ
Province
Please specify country if
born abroad only:
þ ÿ
Country
NAME OF FATHER
Last Name þ ÿ
First Name þ ÿ
Middle Name þ ÿ
MAIDEN NAME OF MOTHER
Last Name þ ÿ
First Name þ ÿ
Middle Name þ ÿ
REGISTERED LATE? No Yes When:
Check (a) appropriate box
Requester's
Tax Identification No.(TIN) - -
(if known)
PLEASE TURN TO BACK PAGE
FOR NSO USE ONLY
TRANSACTION NUMBER : Contact Number:
PURPOSE : Choose one and check (a) appropriate box
Claim Benefits / Loans Employment (Local) School Requirement

Passport / Travel (Specify Country: ) Others (Specify) :


_____________________
Employment (abroad) (Specify Country: _______________ )

REQUESTER'S INFORMATION
Last Name , First Name ,MI

Mailing Address
House No. Street Name / Barangay

City / Municipality

Province

Tel. No.

NOTE : AUTHORIZATION and ID of the document owner together with requester's ID are required if the
requester is NOT any of the following :
a. the owner of the document; d. his/her direct descendant;
b. his/her parent; e. his/her legal guardian/institution-in-charge, if minor;
c. his/her spouse;
I understand that as per PD 603 (Child & Youth Welfare Code),birth certificate documents,if available in this
office cannot be released to me without proper authorization from the owner of the document, his/her parent
(if minor), his/her spouse, his/her direct descendant, or his/her authorized guardian/institution-in-charge.

_____________________________
Signature of Applicant

FOR NSO USE ONLY Converted ? Y N


MONTH DAY YEAR
For CDLI request only:
Date of Filing / / 20
CDLI type : _______________________
Date of Release / / 20 Proper : _________ pages
Attachment : _________ pages
Remarks :

Received by : _____________________________________ Date of receipt : ____________________

THIS FORM IS NOT FOR SALE

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