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pid application form

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