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Birth Application Form

This document is an application form for requesting birth certificates from the National Statistics Office of the Philippines. It provides instructions for filling out the form, including printing clearly, checking appropriate boxes, and providing valid identification for both the document owner and requester. The form requests information such as the birth reference number, names of the owner and parents, place and date of birth. It also requires the purpose of the request, requester's contact information, and notes that authorization is required if the requester is not closely related to the owner.

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Kim-Ezra Agdaca
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© Attribution Non-Commercial (BY-NC)
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7K views

Birth Application Form

This document is an application form for requesting birth certificates from the National Statistics Office of the Philippines. It provides instructions for filling out the form, including printing clearly, checking appropriate boxes, and providing valid identification for both the document owner and requester. The form requests information such as the birth reference number, names of the owner and parents, place and date of birth. It also requires the purpose of the request, requester's contact information, and notes that authorization is required if the requester is not closely related to the owner.

Uploaded by

Kim-Ezra Agdaca
Copyright
© Attribution Non-Commercial (BY-NC)
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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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

First Name

Middle Name

Date of Birth
MONTH DAY YEAR

Place of Birth
City / Municipality

Province
Please specify country if
born abroad only:
Country
NAME OF FATHER
Last Name

First Name

Middle Name
MAIDEN NAME OF MOTHER
Last Name

First Name

Middle Name

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 :
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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