Important Reminders

☐ Your appointment is on 02-May-2025 at 10:00 - 11:00.

Please be at Legazpi (Pacific Mall Legazpi) 15-30 minutes before your scheduled appointment.
☐ Print your application form and e-receipt on an A4-size paper for presentation and submission to your chosen
Consular Office.
☐ Be ready with both the original and photocopies of your documents to avoid delay in the processing of your
application. For reference, you may visit https://consular.dfa.gov.ph/services/passport/requirements
☐ For your civil registry documentary requirements, you may order them online from the Philippine Statistics
Authority through https://www.psaserbilis.com.ph or https://www.psahelpline.ph
☐ Passport processing fee is non-refundable and non-transferable.
☐ If you have paid for passport courier delivery online during the appointment process, your current passport
will be cancelled during your appointment.
There are no available courier delivery services at TOPS Sites. Those who applied at these sites will be unable to
request the delivery of their passports on the day of their appointment schedule.
Hindi available ang courier service sa mga TOPS Sites, dahil dito, hindi maaring mag-request sa TOPS na mai-
deliver via courier service ang inyong passport sa araw ng iyong appointment.

☐ If you have chosen to pick up your passport, you may claim your passports at the respective Supervising
Consular Office (SCO) of the TOPS where you applied. Please click HERE to check the location of the SCO.
Kung pinili ninyong i-pick up ang iyong passport, maari itong kunin sa designated na Supervising Consular office
(SCO) ng TOPS Site kung saan kayo ay nag-apply. I-click ang link na ito para makita ang listahan ng mga SCO.

☐ Note that passports for pick-up must be claimed at the designated SCO and applicants will not be able to
request for passport delivery on the day of their appointment.
Ang mga passports na for pick-up ay kinakailangang kunin sa mga designated na SCO dahil hindi maaring mag-
request ng delivery sa TOPS Site sa araw ng inyong appointment.

☐ Please be reminded that, per Department Order 2021-012, unclaimed passports after one (1) year will be
cancelled.
Mahalagang tandaan na ang mga passports na hindi nakuha ng aplikante sa loob ng isang (1) taon ay i-kakansela,
alinsunod sa Department Order No. 2021-012.
Steps at the Consular Office - Data Capturing Site
Have your appointment verified at the verification section. Present your duly accomplished application
Step 1 form, an ID, and your e-receipt. Please double check that the verifier has signed or stamped your form
before proceeding to the next step.
Present your verified application form and requirements to the processor. Please note that you MAY be
Step 2 required to present other requirements.
If approved, double check that the processor has signed your form.
Proceed to the data capturing /encoding section. Make sure that all information entered is complete and
Step 3 correct before signing on the electronic confirmation page.
For Passporting on Wheels, courier services are mandatory.

Additional Reminders
Photo requirement: dress appropriately; avoid wearing heavy or theatrical make-up
A medical certificate may be required for a medical procedure done on the applicant that may interfere in the
photo or fingerprint capture process.
Applicants are also requested to accomplish the DFA Service Quality Feedback Form by scanning the
corresponding QR Code, visiting the link in the poster attached in this email, or accomplishing the included paper-
based feedback form. Your responses will help us improve our services

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APPOINTMENT DETAILS:
00242025050200071 Republic of the Philippines
Legazpi (Pacific Mall Legazpi) DEPARTMENT OF FOREIGN AFFAIRS
02-May-2025 PASSPORT APPLICATION FORM
10:00 - 11:00

THIS APPLICATION FORM IS NOT FOR SALE. PLEASE DO NOT LEAVE ANY SPACES BLANK, INDICATE NIA IF NOT
APPLICABLE. PROVIDING FALSE STATEM ENTS IN PASSPORT APPLICATION S IS PUNISHABLE BY LAW (R.A. 8239).

GAÑGAN ANTONETTE
LAST NAME/APELYIDO FIRST NAME / PANGALAN (Jr./II/III)
CARULLO NAGA CITY, CAMARINES SUR
MIDDLE NAME/GITNANG PANGALAN PLACE OF BIRTH /POOK NG KAPANGANAKAN
January \ 22 \ 2001 GENDER /KASARIAN MALE FEMALE
Month Day Year
DATE OF BIRTH /PETSA NG KAPANGANAKAN
(Ex.: March 8, 2010)
Civil Status: Single Married Widow/er Legally Separated Annulled
Complete Address: BLOCK 5 LOT 10 NCEHP ZONE 6 SAN FELIPE, NAGA CITY, CAMARINES SUR Tel. No.:
Present Occupation: NURSE Mobile No.: 639615508332
Work Address: Tel. No.:
E-mail Address: acgangan01@gmail.com
Name of Wife / Husband: , Citizenship:
Name of Father: GAÑGAN, GIL JR LELIS Citizenship: PHL
Maiden/Single name of Mother: CARULLO, ELVIRA CORDOVA Citizenship: PHL
Citizenship Acquired By:
Birth Election Marriage Naturalization R.A. 9225 Others
Are you a holder of a foreign passport? Yes No Have you ever been issued a Philippine Passport? Yes No
If Yes, from what country? If Yes, latest Passport Number?
Date of issue: Place of issue:
(For applicants below 18 years old ONLY)
Name of minor's travelling companion:
Companion's relationship: Contact Number:
I SOLEMNLY SWEAR that 1) I am a Filipino citizen. 2) The information I provided in this application are true and correct. 3) The
supporting documents attached are authentic. 4) I am aware that under the law, I am allowed to hold only one Philippine passport at any given
time. 5) I am aware that making false statements in passport application, furnishing falsified or forged documents in support thereof are
punishable by law.
Signature of Applicant or Legal Guardian (for minor applicants)
ORGAN DONATION (Optional) In case of death, I hereby donate [ ] Any organ/tissue [ ] Specific organ Please immediately notify my
family at mobile / tel. no.
FOR USE OF THE DEPARTMENT OF FOREIGN AFFAIRS ONLY. PLEASE DO NOT WRITE BELOW THIS LINE.

REMARKS:

Processor: Encoder: Signing Officer: Transmission Officer:

RECEIVED CANCELLED PASSPORT: RECEIVED NEW PASSPORT:

FOR ADMINISTRATIVE USE ONLY:

E-Receipt No: 25600034416 For more details please visit www.dfa.gov.ph or

www.passport.gov.ph

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Republic of the Philippines

DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. E-Receipt No: 25600034416

PAYMENT DETAILS:
MERCHANT: Paymaya
BRANCH CODE: master-card
REFERENCE NO: 509601518950g1
DATE: 06-Apr-2025
TIME: 09:55

APPOINTMENT NUMBER: 00242025050200071

NAME: ANTONETTE CARULLO GAÑGAN
SITE NAME: Legazpi (Pacific Mall Legazpi)
TRANSACTION: Passport Processing
PROCESSING TYPE: Regular
MODE OF PAYMENT: CARD
SERVICE NUMBER: E-Receipt No: 25600034416

Passport Fee ₱950.00

AMOUNT

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W.en-PH.1.1.2(369.22)
 W.en-PH.1.1.2(369.22)

Republic of the Philippines

DEPARTMENT OF FOREIGN AFFAIRS

ELECTRONIC RECEIPT NO. E-Receipt No: 25600034416

PAYMENT DETAILS:
MERCHANT: Paymaya
BRANCH CODE: master-card
REFERENCE NO: 509601518950g1
DATE: 06-Apr-2025
TIME: 09:55

APPOINTMENT NUMBER: 00242025050200071

NAME: ANTONETTE CARULLO GAÑGAN
SITE NAME: Legazpi (Pacific Mall Legazpi)
TRANSACTION: Passport Processing
PROCESSING TYPE: Regular
MODE OF PAYMENT: CARD
SERVICE NUMBER: E-Receipt No: 25600034416

Passport Fee ₱950.00

AMOUNT

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