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SACLAO DENNIS
LAST NAME / APELYIDO FIRST NAME / PANGALAN (Jr. / II / III)
09/03/1989 MALE
DATE OF BIRTH (Ex. Day/Month/Year) GENDER / KASARIAN
Civil Status: ☐
X Single ☐ Married ☐ Widow/er ☐ Legally Separated ☐ Annulled
Name of Wife / Husband: Citizenship:
Complete Address: Tel. No:
Present Occupation: Mobile No: 09276536718
Work Address:
Email Address: DENNIS_SACLAO@YAHOO.COM Office No:
Name of Father: TEODY CABUNTUCAN SACLAO Citizenship:
Maiden/Single Name of
JOSEPHINE ANSELMO DELA CRUZ Citizenship:
Mother:
Are you a holder of a foreign passport? Have you ever been issued a Philippine Passport?
☐ Yes ☐ No ☐ Yes ☐X No
If Yes, from what country? ___________________ If Yes, latest passport number? _______________
This serves as Affidavit of Support and Consent to Travel This serves as Affidavit of Loss
(for Applicants below 18 years old ONLY) Lost Passport Number:
Name of minor's Issued on:
traveling companion:
Issued by:
Companion's
Relationship: Date lost:
Address / Contact Lost due to:
Number:
Signature of Applicant
REMARKS: