PID Form No.Re p u b l i c o f t h e P h i l i p p i n e s Revision (No.) (Date) PHILIPPINE POSTAL CORPORATION Application Control No.: APPLICATION FOR POSTAL ID CARD Accepting Post Office Code: Accepting Post Office Name: OR No: OR Date: ALL FIELDS WITH ( ) ARE REQUIRED PLEASE READ THE GENERAL TERMS AND CONDITIONS AT THE BACK BEFORE ACCOMPLISHING POSTAL REFERENCE NO. (Leave blank if New Application) THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY. PART I - TO BE FILLED OUT BY THE APPLICANT A. APPLICATION TYPE PURPOSE INITIAL CARD REPLACEMENT NOT Amendment of Name Amendment of Biographic Data Replacement of Damaged Card RENEWAL Replacement of Lost Card Amendment of Authenticating Finger Others B. APPLICANT DETAILS APPLICANT’S NAME (FIRST NAME) (MIDDLE NAME) (LAST NAME) (SUFFIX) GENDER DATE OF BIRTH (MM/DD/YYYY) PLACE OF BIRTH (CITY/MUNICIPALITY) (PROVINCE) (COUNTRY) FATHER’S NAME (FIRST NAME) (MIDDLE NAME) (LAST NAME) (SUFFIX) MOTHER’S MAIDEN NAME (FIRST NAME) (MIDDLE NAME) (LAST NAME) (SUFFIX) NATIONALITY OCCUPATION CIVIL STATUS Single Married Widowed Separated Divorced/Annulled GSIS No.(If GSIS member) SSS No.(If SSS member) TIN No.(If Available) CRN No.(If Available) PHILHEALTH No.(If member) HDMF No.(If member) EYES (COLOR) HAIR (NATURAL COLOR) COMPLEXION TELEPHONE NUMBER MOBILE NUMBER FOR DISTINGUISHING FACIAL FEATURES WEIGHT (KILOS) HEIGHT (CENTIMETERS) EMAIL ADDRESS C. ADDRESS DETAILS PREFERRED MAILING ADDRESS (CHOOSE ONE) PRESENT WORK PRESENT ADDRESS (RM/FLR/UNIT NO./ BLDG. NAME) (HOUSE/ LOT & BLK NO.) (STREET NAME) (SUBDIVISION) (BARANGAY/DISTRICT/LOCALITY) (CITY/MUNICIPALITY) (PROVINCE) (COUNTRY) (POST CODE) WORK ADDRESS EMPLOYMENT STATUS COMPANY TYPE Contractual Regular / Permanent Household Self Employed OFW Government Private Others (COMPANY/RM/FLR/UNIT NO./BLDG. NAME) (HOUSE / LOT & BLK NO.) (STREET NAME) (SUBDIVISION) (BARANGAY/DISTRICT/LOCALITY) (CITY/MUNICIPALITY) (PROVINCE) (COUNTRY) (POST CODE) SALE D. APPLICANT’S CERTIFICATION N ot w it hst anding t he confi den t i a l i t y o f t he da t a t ha t I ha v e suppl i e d he re i n, I he r eby give my Fur ther, all s tatements / data on the FINGERPRINTS IF APPLICANT CANNOT SIGN: consent t hat t he same be sec ure d a nd a c c e sse d f o r subse que nt v a l i da t i o n, v e rifi cation, and oper ator 's s cr een, which wer e s hown to me other purposes consist ent w i t h t he o bj e c t i v e s o f t hi s c a rd e nro l l m e nt . I f urt her affi r m that at or about the time I affi xed my s ignatur e by af fi xing my signat ure on t hi s f o rm , a l l st a t e m e nt s/da t a a ppe a ri ng i n t hi s f or m ar e tr ue, her ein, ar e tr ue, cor r ect and complete to the correct and complet e. While a ppl y i ng f o r t hi s c a rd, I l i k e w i se f ul l y a gre e t o a nd under s tand bes t of my knowledge and belief. all t he t erms of it s issuance a s go v e rne d by P o st a l rul e s a nd re gul a t i o ns. Higit pa r ito, ang aking lagda s a for m na ito Ibi nibigay ko ang aking pahi nt ul o t na ga m i t i n a ng m ga k o m pi de nsy a l na i mpor mas yong ay nagpapatunay na ang lahat ng nakasaad sa it aas sa pagpapa t una y, pa gbe be ri pi k a a t i ba pa ng pa m a m a ra a ng kaugnay s a impor mas yong makikita s a kompyuter s cr een pr oseso ng paggaw a ng Post a l I D . Ang a k i ng l a gda sa f o rm na i t o a y na gpa pa tibay na ang ng oper ator ay totoo, tama at kumpleto s a lahat ng impormasyong maki k i t a sa f o rm na i t o a y t o t o o , t a m a a t k um pl e t o . N a iintidihan ko aking buong kaalaman at paniniwala. r in at sumasang-ayon ako sa m ga a l i t unt uni n a t re gl a m e nt o na sum a sa k l a w sa pagkakar oon ng Post al ID card. RIGHT THUMB RIGHT INDEX APPLICANT’S SIGNATURE APPLICANT’S SIGNATURE WITNESS’ SIGNATURE SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME PART II - TO BE FILLED OUT BY PHLPOST SUPPORTING DOCUMENTS PRESENTED: APPROVED BY: NSO Birth Certificate Barangay Certificate Others SIGNATURE OVER PRINTED NAME DATE DATA CAPTURE SCHEDULE DATA CAPTURED BY: DATE SCREENED BY: Capturing Post Office Name / Code: SIGNATURE OVER PRINTED NAME DATE Date / Time: SIGNATURE OVER PRINTED NAME TEAR HERE Re p u b l i c o f t h e P h i l i p p i n e s Application Control No.: PHILIPPINE POSTAL CORPORATION Accepting Post Office Code: APPLICATION FOR POSTAL ID CARD AC K N OW LE D GE M E N T S L IP ( C L IENT CO PY ) Accepting Post Office Name: OR No : OR Date: POSTAL REFERENCE NO. (Leave blank if New Application) NAME (FIRST NAME) (MIDDLE NAME) (LAST NAME) (SUFFIX) APPROVED BY: DATA CAPTURE SCHEDULE: DATA CAPTURED BY: Capturing Post Office Name / Code: SIGNATURE OVER PRINTED NAME DATE Date / Time: SIGNATURE OVER PRINTED NAME DATE ___. Notary Public Book No. Series of ___. or allowing the card to be used by another person is not allowed and it may result in confiscation and/or termination of the card as well a legal action/s by government enforcement agencies and PHLPost. ___. stolen or damaged.com . f. k. The card is the property of the cardholder. The cardholder is responsible for the proper use of his/her card at all times and must keep the card secure. the cardholder agrees to the terms of its issuance as governed by the PHLPost regulations. SUBSCRIBED AND SWORN to before me this ____________. By applying for and/or using the card. The Improved Postal ID is issued exclusively by PHLPost as proof of address and identity of the cardholder. The cardholder may request for replacement of the lost.bld. using another person’s card.09175215373.phlpost. c. j. If the cardholder is found to have provided false information.09253212291. stolen or damaged card to any post office. h.ph E-mail Address: phlpostal. The PHLPost is not responsible for any unauthorized use of the card or for any loss arising from the failure of the cardholder to comply with item G of this guideline. falsified documents or has willingly applied for a Postal ID through fraudulent means. If card is lost. Sun . Metro Manila Website: www.gov. m. [email protected]. and shall not be used without the express consent of the data subject. The personal information that PHLPOST being provided is necessary to complete this application and/or transaction. Alteration or intentional damage to the card. Globe .payment@gmail. call and/or mail within five (5) working days: Mailing address: The Postal Payment Delivery Division Mobile No: (0917) 5215373 Business Lines Department (0998) 8847629 5/F Manila Central Post Office Bldg.com ppsddiv. subject to compliance to the requirements for replacement and payment of applicable fees and charges. d. The card is valid for three (3) years for Filipinos and foreign residents with Diplomatic Visa for foreign government officials/ personnel serving in foreign embassies or consulates in the Philippines. (0925) 3212291 Magallanes Drive 1000 Manila. Smart . the cardholder must report to the Postal Payment Delivery Division. Long Stay Visitor Visa Extension. e.facebook. Please Call Customer Service Service Hotline (02) 742-7349 / (02) 230-9875. Privacy Statement. b.09988447629. he/she may be subjected to legal action/s and/or sanction/s. Said information will be kept confidential and secure. Mondays to Fridays from 8AM to 5PM Visit: www.com i. GENERAL TERMS AND CONDITIONS: a. email. affiant exhibited to me his _________________. The card is non-transferable.com/newpostalid. www. For Inquiries. l. Temporary Resident Visa and Special Resident Retiree’s Visa while one (1) year for foreign residents holding Alien Certificate Registration Identity Card and any equivalent document allowing the applicant to stay in the Philippines for three (3) months or more issued by the Bureau of Immigration and or Department of Foreign Affairs. ___. A unique Postal Reference Number (PRN) is assigned to each cardholder. Doc.. Page No. g. Business Lines Department (PPSD-BLD) by SMS.