PASTE

APPLICATION FOR ID / MOST RECENT

2”x 2”

ACCESS PASS
color photo with
white background

NEW RENEWAL Year issued _________ ID# ____________ DO NOT STAPLE

PROFESSIONAL DATA (ALL INFORMATION MUST BE TYPED OR PRINTED. MARK “” WHERE APPLICABLE. DO NOT LEAVE BLANKS)

1. NAME (Last, First, Middle)

2. COMPANY/AGENCY
3. SECTION/DEPARTMENT
4. POSITION/DESIGNATION

5. EMPLOYMENT STATUS Regular/Permanent Contractual/Casual/Prob. Others (specify)__________________________

Others
6. EMPLOYER ADDRESS

7. OFFICE PHONE / FAX

EMPLOYMENT HISTORY for LAST FIVE YEARS (IF NONE, SO STATE. LIST MOST RECENT EMPLOYMENT FIRST)
8. FROM TO COMPANY NAME POSITION REASON FOR LEAVING

PERSONAL DATA
9.
9. HOME ADDRESS

10. CONTACT NUMBER 11. EMAIL ADDRESS

12. CITIZENSHIP 13. CIVIL STATUS 14. SEX M F
14.
15. PROVINCIAL ADDRESS
ADDRESS
16. DATE OF BIRTH (MM-DD-YYYY)
6. 17. PLACE OF BIRTH

18. CHARACTER REFERENCES (PERSONS NOT RELATED BY CONSANGUINITY OR AFFINITY TO ID APPLICANT)

NAME RELATIONSHIP CONTACT DETAILS

I hereby certify to my knowledge that the foregoing information supplied hereon is true and accurate to the best of my knowledg e and belief. I am
fully aware that the issuance of the NAIA ID is a privilege granted by the MIAA. Any violation committed against its rules and regulations pertaining
to the proper use of the ID & Access Pass is ground for revocation of this privilege.
We hereby certify that the applicant is a bona fide employee of our company. We confirm that we have conducted a background investigation, to
wit: a) Checked on character references indicated on the ID card application and, b) Checked the employment history of the applicant covering at
least five years preceding this application.
IMPORTANT: PLEASE READ CONDITIONS AT THE BACK BEFORE SIGNING THIS APPLICATION
19. SIGNATURE OF APPLICANT 20. ENDORSING AUTHORITY
(must be within box lines only) (signature above printed name & position)
FOR ID & PCD USE ONLY

Form S-IPC-F-004 rev. 2

All information required must be supplied. Incomplete and illegible application will not be processed. Inquiries may be directed at the ID & Pass Control Division at
88771109 loc.3190/ 3823/4017/4018 (AID/SID) 3916/2790 (MP). This form is NOT FOR SALE and may be photocopied. Only clear copies will be processed.
 21. GENERAL TERMS AND CONDITIONS
Processing of ID/Access Pass applications

1. Only signed ID/Access Pass applications that have been completed and where all required documents have been
attached will be processed.
2. The payment obligation arises on application. If the ID card is not collected within three months of notification, the
data will be deleted and the ID card destroyed (the payment obligation remains).
3. By signing, you (applicant) agree to the following:
a. That I consent to the processing of my personal and sensitive personal information for the purpose of your
application as defined under R.A. 10173 otherwise known as “Data Privacy Act of 2012”;
b. That I recognize and understand the rules governing the use of the NAIA ID/Access Pass;
c. That I will undergo a background check based on the National Civil Aviation Security Program (NCASP) and
such other relevant issuance by competent authorities;
d. That my data will be processed, evaluated and shared (disclosed) by the Manila International Airport
Authority, for confirmation and verification, to such other third party affiliate, may it be other government
agency or any private party, duly authorized by MIAA;
e. That my data will be retained for 5 years from the time of the cessation of any need for the retention of the
necessary information or from the notice of cancellation of my ID/Access Pass whichever is later. That I agree
that my information will be deleted/destroyed after this period.

__________________________________(Applicant shall print his/her name and sign the space provided if he agrees with the terms)

4. The employer of the applicant warrants the following:

a. That the applicant's information is correct and complies with the personnel document specified;
b. That the ID/Access Pass shall be required at all times, which shall be reflected in the company written policy;
c. That the application shall only pertain to the areas needed to be accessed for work purposes;
d. That the ID/Access Pass will be returned correctly upon termination of employment or assignment at NAIA;
e. That I shall adhere at all times to the duly promulgated rules and regulations by MIAA and such other
competent authorities as the case maybe.

 ________________________________________Employer shall print his/her name and sign in the space provided if he agrees with the terms)

5. The employer of the applicant confirms the following and promises to fulfil the following obligations below:
a. Any required work visa for the applicant is present and will be submitted to ID & Pass Control Division;
b. That I would bear the costs arising in accordance with the table of fees for processing the application, issuing
the ID/Access Pass and payment for ID/Access Pass which are lost or not returned on time;
c. That the ID & Pass Control Division has a current and valid specimen signature of the company's authorized
signatory/ies;
d. That I will notify the ID & Pass Control Division immediately if the employment relationship ends, there is no
further employment at the Airport or other prerequisites for holding an ID card no longer apply.

 ______________________________________(Employer shall print his/her name and sign in the space provided if he agrees with the terms)

Information on data protection

Personal and Sensitive Personal Information shall be processed for the purpose of issuing or changing an ID/Access
Pass which will be stored and evaluated by the ID &Pass Control Division as part of the evaluation of applications.
Series of verifications and background check shall be applied on the collected information, in which case, such
information may be sent to the appropriate aviation security authority, stored to such facility for evaluation and
processing. Persons aggrieved by this policy may contact the National Privacy Commission if he or she believes that
his/her rights have been violated as part of the collection, processing and use of his/her personal data by non-public
agencies as stipulated under the Data Privacy Act of 2012. Personal Information and Sensitive Personal Information
collected may be processed by third party affiliates, for purposes stated in relevant regulations.