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PIO FomNa. Revision No) (Dat) Appian Conta Na: ‘Acetng Po fice ade ‘cep ost fice Nae Ono Taba: PHLPOST SS. punscome 06st esis satis APPLICATION FOR POSTAL ID CARD RASNAD HE CEAL TINE DCAD oe ALLFIELDS WITH (~~ ) ARE REQUIREDss om rr ; " PARTI -TO BE FILLED OUT BY THE APPLICANT EW batas PURPOSE CARDTYPE DELIVERY |CLCARD REPLACEMENT Ceme [eae | Once | rag Fomine C1 fenewat DO Prexuns Claus ] Amendment of Blogaphic Data others B. APPLICANT DETAILS Srennee nares ee en “GENDER 7 GATE BURTH (MM7DB/¥PYY) 7 PLACE OF BIRTH (CTY/MUNICIPALITY SW TROVINCE) 7 Ton A) ee |e] ale epee ene jee il = NAOMI ppeuraion banal single D Marg Widowed Cseparated Cdivorced/znnuiied | l | | ee (eel ES | | corsa rates wala {| | 1 |_| {11/11 11 1 | L l | essa PREFERRED MAILING ADDRESS (cvoose one PRESENT WwoRK (GFT (steer nae anacTOITRIETABALIT LititJilitittity tt Lititititi tigi tii tit (arvvwaraury) aor oun yrost one Meee (CONPARVRAFATUNITNO/ BLOG. RANE) (HOUSE LTE BLK) (steer nae ett PIII | L I1iti11Ititt ‘Gusonson anaicRoISTRIETBCALTY Lititjilitittitj it Litititttiipittitit (arvana) PHONG out (Post obey Eee ENGERPRINTS IF APPLICANT CANNOT IG ‘Notwithstanding the confident ofthe dt that have spleen nee ie ‘the urpoes content wth th objec ofthc emer. rte a ty “fang my spate on ths form a tenants appeanng nts fxm and on he ty Postale eine . [APPLICANT'S SIGNATURE NS WITNEss’siGNATURE SIGNATURE OVER PRINTED NAME ATE SIGNATURE OVER PRINTED NAME PART Il-TO BE FILLED OUT BY PHLPOST ‘SUPPORTING DOCUMENTS PRESENTED: ‘APPROVED BY: Lnsosinncercae 1D xangay cette Dotter 'HGHATURE OVER PRINTED NAME DAE en carton scout DATA CAPTURED BY SCREENED By Capturing Pst fice ame Cote SIGNATURE OVER PAINTED NAME DATE | Date/Time —SINATURE OVER PAINTED NAME DATE TEAR HERE =~ iepulblic oF the Bhilippines |” picaun nto PHLPOSTS. PHILIPPINE POSTAL CORPORATION | jet APPLICATION FOR POSTALIDCARD) 3". ACKNOWLEDGEMENT SLIP ( CLIENT COPY ) FORALREFEENCENGTe im GAN” RANE pa rors warn a ‘APPROVED BY ‘DATA CAPTURE SCHEDULE DATA CAPTURED BY Capturing Pst Ofc Name Cote SIGNATURE OVERPRINTED NAME DATE Date Tie SIGNATURE OVER PRINTED NAME DATE For inquiries, Please CallCustomer Service Hotline 5275409

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