Revision (No.)(Date) R evision (No. )(Dat PHILIPPINE POS ...

1 Republic of the Philippines Revision (No.). PID Form No.(Date). PID Form No. P H I L I P P I N E RPe O. p uSbTA. l i c LoRfCetO R. e bP. phu iO. Pl hci R. loi pAT. f pt ihIneO. e sPNh i l iApplication p p i n e s Control No. : Revision (No.) Revision (Date) (No.) (Date). PID Form No. APPLICATION FOR POSTAL ID CARD P H I L I P PPI N. HEI LPI P. OPSITA. NR eE. pLuP. bClO. iO. c So RTA. f Pt hO. Le RPChAT. O R. I pO. ilip Pi nN. Oe sR AT I O NControl Application No. Revision Application : Control(No.). No.(Date). : P H I L I P P I N E P O S TA L C O R P O R AT I O N. APPLICATION. APPLICATION FOR FOR. POSTAL POSTAL IDIDCARD. ID CARD. Application OR No : Control No. :PID Form No. : OR Date APPLICATION FOR POSTAL CARD. R e p u bAT. PLEASE READ THE GENERAL TERMS AND CONDITIONS l i THE. c oBACK. f t hBEFORE. e P hACCOMPLISHING. ilippines Revision (No.) (Date). ALL FIELDS WITH ( ) ARE REQUIRED.

2 THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY. POSTAL REFERENCE NO. (Leave blank if New Application). PPLEASE. H I LREAD. ITERMS. PP IN E P TERMS. O S TA LCONDITIONS. C O R PATO R AT I O N ORApplication No : OR No No. :: OR Date : OR Date : PLEASE READ THE GENERAL THE. AND. GENERAL. CONDITIONS AT. ANDTHE BACK BEFORE ACCOMPLISHING OR No : Control THE BACK BEFORE ACCOMPLISHING OR Date : New(Leave APPLICATION FORPART POSTAL ID CARD. PLEASE READ THE GENERAL TERMS AND CONDITIONS AT THE BACK BEFORE ACCOMPLISHING POSTAL REFERENCE (Leave blank ifNO. ALL FIELDSALL. WITH. FIELDS. ( WITH) ARE( REQUIRED. ALL FIELDS WITH (. ) ARE REQUIRED. ) ARE REQUIRED. I - TO BE FILLED OUT BY THE APPLICANT. THIS FORM. PRINT ALL THISINFORMATION IN CAPITAL. FORM. PRINT ALL INFORMATION LETTERS. IN CAPITAL LETTERS. AND USE BLACK INK. AND. THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY.))

3 USE BLACK. ONLY. INK ONLY. Application). POSTAL REFERENCE NO. (Leave blank if New Application). blank if New Application). A . APPLICATION TYPE. R e p u b l i c o f t h e P h i l i p pPART I - PART. TO BEIBE. PID Form No. FILLED. - Revision TO BE. (No.)OUTFILLED BY THE. OUT. OR No : APPLICANT. BY THE. OR Date : POSTALAPPLICANT. PLEASE READ THE GENERAL TERMS AND CONDITIONS AT THE BACK BEFORE ACCOMPLISHING. ALL FIELDS WITH ( ) ARE REQUIRED. ines PART. THIS FORM. PRINT ALL I - TO. TO. -CARD. INFORMATION FILLED. IN CAPITAL. REPLACEMENT LETTERSOUT. OUT. (Date) BY. AND USE THE. BLACK APPLICANT. APPLICANT. INK ONLY. REFERENCE NO. (Leave blank if New Application). P H IPURPOSE CARD. L I P P I N E P O S TA L TYPEC O R P O R AT DELIVERY. I O N Application Control No. APPLICATION. A. : APPLICATION . APPLICATION.. APPLICATION. Amendment of Name TYPE. TYPE TYPE. TYPE Amendment of Authenticating Finger N FOR POSTAL ID CARD.

4 INITIAL BASIC REGULAR. PURPOSE PURPOSE. PURPOSE DELIVERY DELIVERYCARDCARD. REPLACEMENT PART I - TO. CARDofREPLACEMENT BE FILLED. Replacementof Lost CardOUT BY THE APPLICANT. Replacement of Damaged Card CARD TYPE. RENEWAL CARDCARD. TYPE TYPE. PREMIUM DELIVERY. RUSH REPLACEMENT. Amendment OR No : ORBiographic Date : Data Amendment A . APPLICATION TYPE. ofAmendment AmendmentName of Name of Name Others Amendment Amendment ofofAuthenticating Amendment Authenticating of Authenticating Finger Finger Finger NOT. LostDETAILS. PLEASE INITIAL. READ THE GENERAL TERMS AND CONDITIONS. INITIAL. INITIAL BASIC AT THE BACK BEFOREREGULAR. BASIC ACCOMPLISHING. REGULARREGULAR. BASIC POSTALR eplacementof REFERENCE. FORM. PRINTPURPOSE. ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY. RENEWAL CARDPREMIUM. TYPE DELIVERY. RUSH CARD. Replacementof Lostblank (Leave Replacementof REPLACEMENT.)

5 Card Lost ifCard Card New Application) Replacement Replacement ofofReplacement PID. PID. Damaged Damaged Form Form No. No. Card Card of Damaged Card RENEWAL NAME. APPLICANT'S (FIRSTPREMIUM. RENEWAL NAME) PREMIUM. RUSH RUSH (MIDDLE NAME)ofAmendment Amendment Amendment Amendment Reeof ppBiographic RBiographic of offfData uubblliicc Data Name oo Biographic ppppiinneess (LAST NAME) Others tthhee PPhhiilliiData Others Others Revision AmendmentRevision (No.)(Date). (No.) (Date). of Authenticating Finger (SUFFIX). PART I INITIAL. - TO BE FILLED. RENEWAL. OUT BY THEREGULAR. BASIC APPLICANT B. HIILLIIPPB. PPH P N B. APPLICANT. APPLICANT. NAPPLICANT. OOSSB. PIIR eplacementof EE PP TA. TA APPLICANT. LLCard Lost CCOORRPPDETAILS. DETAILS. DETAILS. ORRAT. O DETAILS. ATIIO. O N Application N ApplicationReplacement No.:: of Damaged Card ControlNo. Control PREMIUM RUSH. APPLICATION FOR POSTAL ID CARD.

6 A(FIRST..OFAPPLICATION TYPE. APPLICANT'S NAMEDATE BIRTH (MM/DD/YYYY) PLACE OF BIRTH (CITY/MUNICIPALITY) (PROVINCE)NAME) (LAST NAME) (COUNTRY). Amendment of Biographic Data Others PLICANT'SGENDER. NAME. APPLICANT'S. (FIRST NAME. NAME) NAME). (FIRST NAME) (MIDDLE(MIDDLE. NAME)NAME). (MIDDLE NAME) (LASTNAME). (LAST (SUFFIX). (SUFFIX) (SUFFIX. DELIVERY CARD REPLACEMENT B. APPLICANT DETAILS ORNo OR No :: ORDate OR Date:: APPLICANT'S. FATHER'S. GENDER. REGULAR. NAME. NAME DATE OF BIRTH. (FIRST. Amendment NAME)(MM/DD/YYYY). of Name PLACE OF BIRTH. PLEASE. PLEASE (CITY/MUNICIPALITY). READ. READ (MIDDLE. Amendment THEGENERAL. THE GENERAL NAME). TERMS. TERMS AND. AND ofCONDITIONS. Authenticating CONDITIONS AT THEF inger ATTHE BACKBEFORE. BACK (PROVINCE). BEFOREACCOMPLISHING. ACCOMPLISHING (LAST NAME) (COUNTRY) (SUFFIX). NDER DATE OF BIRTH. GENDERALL FIELDS. ALL (MM/DD/YYYY). DATE OF BIRTH.)

7 FIELDS WITH. WITH ((. Replacementof Lost Card PLACE OF BIRTHTHIS. (MM/DD/YYYY). )) ARE PLACE. (CITY/MUNICIPALITY). ARE REQUIRED. REQUIRED. OFPRINT. THISFORM. BIRTH. (CITY/MUNICIPALITY). ALLR eplacement ALL INFORMATIONIN. INFORMATION CAPITAL. CAPITAL. INof Damaged LETTERS. LETTERS. Card AND USEBLACK. ANDUSE BLACKINK. (PROVINCE). INKONLY. ONLY. POSTAL(PROVINCE). POSTAL REFERENCENO. REFERENCE NO.(Leave (COUNTRY). (Leave blankififNew blank (COUNTRY). NewApplication). Application). RUSH Amendment of Biographic Data Others GENDER. FATHER'S MAIDENDATE(FIRST. MOTHER'SNAME OF BIRTH (MM/DD/YYYY). NAME) PLACE OF BIRTH (CITY/MUNICIPALITY). (MIDDLE NAME) (LAST NAME) (PROVINCE). (LAST NAME) (COUNTRY) (SUFFIX). THER'S NAME. FATHER'S. NAME NAME. (FIRST B. APPLICANT. NAME) (FIRST NAME) DETAILS PART. (MIDDLEIINAME). PART -- TO. TO BE FILLED. BE. (MIDDLEFILLED. NAME) OUT BY. OUT BY THE.

8 THE APPLICANT. APPLICANT. (LAST NAME) (LAST NAME) (SUFFIX) (SUFFIX. FATHER'S. MOTHER'SNAME. (MIDDLE NAME). MAIDEN (FIRST NAME) OCCUPATION. NATIONALITY. (LAST NAME). CIVIL AA .. APPLICATION. STATUSNAME). (MIDDLE APPLICATION TYPE. TYPE (SUFFIX). (LAST NAME) (SUFFIX). Single Married Widowed Separated Divorced/Annulled OTHER'S NAME. MAIDEN. MOTHER'S MAIDEN. (FIRST. PURPOSE. PURPOSE NAME) (FIRSTCARD NAME)TYPE. CARD TYPE DELIVERY. DELIVERY CARD(MIDDLE. CARD. (MIDDLE NAME) REPLACEMENT. REPLACEMENT. NAME) (LAST NAME) (LAST NAME) (SUFFIX) (SUFFIX. PLACE OF BIRTH (CITY/MUNICIPALITY) (PROVINCE) (COUNTRY). NAME. GSIS No.(If GSIS member) SSS No.(IfAmendment SSS member)of Amendment ofName Name TINA mendment No.(If Available Amendment )AuthenticatingFinger ofAuthenticating of Finger MOTHER'S. NATIONALITY MAIDEN. INITIAL(FIRST NAME) OCCUPATION. INITIAL BASIC. BASIC REGULAR. REGULAR CIVIL STATUSNAME).)

9 (MIDDLE (LAST NAME) (SUFFIX). Replacementof Replacementof SingleLostCard Lost Card Married Replacementof Replacement Widowed ofDamaged Damaged Card Separated Card Divorced/Annulled TIONALITY NAME. NATIONALITY RENEWALOCCUPATION PREMIUM. RENEWAL. (MIDDLE NAME) OCCUPATION. PREMIUM RUSHCIVIL STATUS. RUSH. (LAST NAME) CIVIL STATUSof Amendment Amendment ofBiographic BiographicData Data Others Others CRN. GSISNo.(If No.(IfAvailable ). GSIS member) PHILHEALTH. SSS No.(If CIVIL STATUS Single SSSNo.(If member). member) Single Married (SUFFIX) Married Widowed TIN. HDMFNo.(If Widowed Available No.(If member) ) Separated Separated Divorced/AnnulledDivorced/Annu NATIONALITY OCCUPATION. B. APPLICANT. B. APPLICANT. Single DETAILS. DETAILS. Married Widowed TIN No.(If Available )Separated TIN No.(If Available ) Divorced/Annulled IS No.(If GSIS GSIS. member). No.(If GSIS member). (MIDDLE NAME) SSSNAME).

10 (LAST No.(If SSS member). SSS No.(If SSS member) (SUFFIX). APPLICANT'S. APPLICANT'S NAME. NAME (FIRSTNAME). GSIS No.(If GSIS member)(FIRST NAME) (MIDDLENAME). (MIDDLE NAME) (LASTNAME). (LAST NAME). TIN. TELEPHONE NUMBER No.(If Available ) MOBILE NUMBER. (SUFFIX). (SUFFIX). GSISNo.(If EYES. CRN No.(IfAvailable (COLOR)GSIS member). ) HAIR (NATURAL COLOR) PHILHEALTH COMPLEXION. SSS No.(If SSSNo.(If member). member) HDMF No.(If member). N No.(If Available ) CIVILA vailable CRN No.(If GENDER. GENDER STATUSDATE) OF. DATE OFBIRTH. BIRTH(MM/DD/YYYY). (MM/DD/YYYY) PLACE. PLACE OFBIRTH. OF PHILHEALTH. BIRTH No.(If PHILHEALTH. member) No.(If member). (CITY/MUNICIPALITY). (CITY/MUNICIPALITY) (PROVINCE). (PROVINCE) HDMF No.(If member). HDMF No.(If member). (COUNTRY). (COUNTRY). DISTINGUISHING. CRN. EYES No.(If (COLOR) FACIAL. Available Single ) FEATURES WEIGHT. Married HAIR (KILOS).)