PID Form No. Revision (No.) (Date) Republic of the Philippines PHILIPPINE POSTAL CORPORATION Application Control No.: Accepting Post Office Code: Accepting Post Office Name: OR No: APPLICATION FOR POSTAL ID CARD ALL FIELDS WITH ( ) ARE REQUIRED OR Date: POSTAL REFERENCE NO. (Leave blank if New Application) PLEASE READ THE GENERAL TERMS AND CONDITIONS AT THE BACK BEFORE ACCOMPLISHING 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 CARD REPLACEMENT DELIVERY INITIAL REGULAR RENEWAL RUSH Amendment of Name Replacement of Lost Card Amendment of Biographic Data Amendment of Authenticating Finger Replacement of Damaged Card Others B. APPLICANT DETAILS APPLICANT’S NAME (FIRST NAME) GENDER DATE OF BIRTH (MM/DD/YYYY) (LAST NAME) (SUFFIX) (PROVINCE) PLACE OF BIRTH (CITY/MUNICIPALITY) (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 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 DISTINGUISHING FACIAL FEATURES WEIGHT (KILOS) HEIGHT (CENTIMETERS) EMAIL ADDRESS Divorced/Annulled MOBILE NUMBER C. ADDRESS DETAILS PREFERRED MAILING ADDRESS (CHOOSE ONE) PRESENT WORK PRESENT ADDRESS (HOUSE/ LOT & BLK NO.) (RM/FLR/UNIT NO./ BLDG. NAME) (STREET NAME) (BARANGAY/DISTRICT/LOCALITY) (SUBDIVISION) (CITY/MUNICIPALITY) (PROVINCE) WORK ADDRESS EMPLOYMENT STATUS Contractual Regular / Permanent (COUNTRY) Household (COMPANY/RM/FLR/UNIT NO./BLDG. NAME) Self Employed (POST CODE) COMPANY TYPE Government OFW Private Others (STREET NAME) (HOUSE / LOT & BLK NO.) (BARANGAY/DISTRICT/LOCALITY) (SUBDIVISION) (CITY/MUNICIPALITY) (COUNTRY) (PROVINCE) (POST CODE) D. APPLICANT’S CERTIFICATION F u rth e r, a ll state ments/data on th e o p e rator's scre en, wh ich we re sh o wn to me cor rect and complete. While appl yi ng fo r thi s ca rd , I l i kewi se ful l y agree to and u n d erstan d all the terms of its issuan ce as gov er ned by Pos tal rul es and regul at i ons. Ibinibigay ko ang aking pahi nt ul ot na gam i ti n ang m ga kom pi densyal na i mp o rma syo n g nakasaad sa itaas sa pagpa patunay, pagbeberi pi ka at i ba pang p amam araang ka u g n ay sa proseso ng paggawa ng Pos tal I D . Ang aki ng l agda sa f orm na i to ay nagpapa tib a y n a a n g lahat ng impormasyong maki ki ta sa f or m na i t o ay to too, tam a a t kum pl eto. N a iin tid ih an ko rin a t sumasang-ayon a ko sa m ga al i t untuni n at regl am ento na sum as akl aw sa pagkakaro on ng Postal ID card. FINGERPRINTS IF APPLICANT CANNOT SIGN: h e re in , a re t rue, corre ct a n d co mp le te to th e b e st of my kn o wle d g e a n d b e lie f. Hig it p a rito , an g a kin g la g d a sa fo rm n a ito a y n a g p a p a tu n a y n a an g lahat n g imp orma syo n g ma kikita sa ko mp yu te r scre e n n g o p era to r a y to to o , ta ma at ku mp le to sa a kin g b u o n g ka a la ma n a t p a n in iwa la . RIGHT THUMB APPLICANT’S SIGNATURE SIGNATURE OVER PRINTED NAME DATE RIGHT INDEX WITNESS’ SIGNATURE APPLICANT’S SIGNATURE SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME PART II - TO BE FILLED OUT BY PHLPOST SUPPORTING DOCUMENTS PRESENTED: APPROVED BY: ADDRESS VERIFIED: Proof of Identity SIGNATURE OVER PRINTED NAME Proof of Address Others SIGNATURE OVER PRINTED NAME DATE DATA CAPTURE SCHEDULE Capturing Post Office Name / Code: DATA CAPTURED BY: Date / Time: SIGNATURE OVER PRINTED NAME Application Control No.: Re p u bl i c o f t h e P h i l i p p i n e s PHILIPPINE POSTAL CORPORATION Accepting Post Office Code: APPLICATION FOR POSTAL ID CARD Accepting Post Office Name: OR No : OR Date: ACKNOW LEDGEM ENT SLIP ( CLIENT COPY ) NAME (FIRST NAME) APPROVED BY: SIGNATURE OVER PRINTED NAME (MIDDLE NAME) DATA CAPTURE SCHEDULE: Capturing Post Office Name / Code: DATE LC Signature Over Printed Name DATE TEAR HERE POSTAL REFERENCE NO. (Leave blank if New Application) PID-PRN: DATE Date / Time: (LAST NAME) (SUFFIX) DATA CAPTURED BY: SIGNATURE OVER PRINTED NAME DATE NOT FOR SALE NOT FOR SALE (MIDDLE NAME) GENERAL TERMS AND CONDITIONS: a. The Improved Postal ID is issued exclusively by PHLPost as proof of address and identity of the cardholder. b. The card is the property of the cardholder. c. The card is non-transferable. d. A unique Postal Reference Number (PRN) is assigned to each cardholder. e. 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, Long Stay Visitor Visa Extension, 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. f. The cardholder is responsible for the proper use of his/her card at all times and must keep the card secure. g. Alteration or intentional damage to the card, using another person’s card, 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. h. If card is lost, stolen or damaged, the cardholder must report to the Postal Payment Delivery Division, Business Lines Department (PPDD-BLD) by SMS, email, call and/or mail within five (5) working days: Mailing address: E-mail Address: The Postal Payment Delivery Division Business Lines Department 5/F Manila Central Post Office Bldg. Magallanes Drive 1000 Manila, Metro Manila Mobile No: (0917) 5215373 (0998) 8847629 (0925) 3212291 Website: www.phlpost.gov.ph phlpostal.payment@gmail.com ppsddiv.bld.phlpost@gmail.com i. The cardholder may request for replacement of the lost, stolen or damaged card to any post office, subject to compliance to the requirements for replacement and payment of applicable fees and charges. j. 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. k. If the cardholder is found to have provided false information, falsified documents or has willingly applied for a Postal ID through fraudulent means, he/she may be subjected to legal action/s and/or sanction/s. l. By applying for and/or using the card, the cardholder agrees to the terms of its issuance as governed by the PHLPost regulations. m. Privacy Statement. The personal information that PHLPOST being provided is necessary to complete this application and/or transaction. Said information will be kept confidential and secure, and shall not be used without the express consent of the data subject.. For Inquiries, Please Call Customer Service Service Hotline (02) 742-7349 / (02) 230-9875, Globe - 09175215373, Smart - 09988447629, Sun - 09253212291, Mondays to Fridays from 8AM to 5PM Visit: www.facebook.com/newpostalid, www.postalidph.com