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Travel Document Form Only the following States are within the jurisdiction of the Philippine Consulate General, Chicago : (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, North Dakota, South Dakota, Ohio, and Wisconsin) GENERAL REQUIREMENTS FOR ISSUANCE OF A TRAVEL DOCUMENT 1. Duly accomplished Travel Document Application Form, typed or printed legibly in black or blue ink. Parents may accomplish the form for minors. 2. Affidavit of Explanation, duly notarized by a Notary Public - stating the circumstances surrounding the request for a Travel Document. Documentary proof in support of the urgent necessity to travel (i.e. medical certificate – for medical emergencies; death certificate – death of immediate family member). 3. Original and photocopy of Philippine passport data page/s. If lost passport, submit the following: a) Philippine Statistics Authority (PSA) Authenticated Birth Certificate (original and photocopy). Applicant may apply for the PSA birth certificate on-line at https://www.psaserbilis.com.ph/. b) Philippine Statistics Authority (PSA) Authenticated Marriage Certificate (original and photocopy). Applicant may apply for the PSA marriage certificate on-line at https://www.psaserbilis.com.ph/. c) Police Report – if the lost passport is still valid. d) Government Issued ID (e.g. photocopy of Driver’s license, state ID, employment ID) 4. Four (4) colored photos (2" x 2"), front view, with plain white background taken within the last six (6) months. Photo must show applicant in proper attire without eyeglasses. Blurred or low quality photos are not accepted. 5. Copy of Resident Alien Card / Permanent Resident Card or US visa. 6. For minors, submit a notarized Affidavit of Support and Consent from both parents. 7. Copy of airline ticket/itinerary of travel to the Philippines. The date of travel should not be beyond one (1) month from the date of application. (NOTE: Before purchasing the airline ticket, check with the airlines if they will honor the Travel Document in lieu of a passport.) 8. CONSULAR FEE: $30.00 - Travel Document Applicant has to send the corresponding fee in money order or bank draft payable to the “Philippine Consulate General”. NO PERSONAL CHECKS ARE ACCEPTED 9. If Travel Document is to be mailed back – provide a Self-Addressed Stamped Envelope with appropriate stamps and tracking number (USPS Express or Priority Mail) or prepaid UPS is required. REPUBLIC OF THE PHILIPPINES DEPARTMENT OF FOREIGN AFFAIRS PHILIPPINE CONSULATE GENERAL SAN FRANCISCO *FAFORM79BSF* FA FORM 79B APPLICATION FOR PHILIPPINE TRAVEL DOCUMENT PLEASE PROVIDE REQUIRED INFORMATION COMPLETELY AND PRINT LEGIBLY. LAST NAME MIDDLE NAME 2” x 2” PHOTO FIRST NAME FOUR (4) PIECES DATE OF BIRTH (MONTH / DAY / YEAR) SEX MALE FEMALE COLORED, PLAIN WHITE PLACE OF BIRTH AGE BACKGROUND, TAKEN WITHIN LAST SIX MONTHS CIVIL STATUS OCCUPATION SINGLE MARRIED WIDOW/ER DISTINGUISHING MARK, IF ANY: NAME OF SPOUSE, IF MARRIED CITIZENSHIP OF SPOUSE IF WIDOWED OR DIVORCED, NAME OF PREVIOUS SPOUSE CITIZENSHIP OF PREVIOUS SPOUSE NAME OF FATHER (FIRST NAME, LAST NAME) CITIZENSHIP (AT TIME OF APPLICANT’S BIRTH) MAIDEN NAME OF MOTHER (FIRST NAME, LAST NAME) CITIZENSHIP (AT TIME OF APPLICANT’S BIRTH) US ADDRESS PHONE NO. / MOBILE NO.: PHILIPPINE ADDRESS E-MAIL: PHILIPPINE CITIZENSHIP ACQUIRED BY: HAVE YOU EVER BEEN ISSUED A PHILIPPINE PASSPORT? BIRTH YES NO IF YES, LATEST PASSPORT NO. NATURALIZATION ELECTION DATE OF ISSUE PLACE OF ISSUE R.A. 9225 (DUAL CITIZENSHIP LAW) OTHER: _________________________ REASON FOR APPLYING A TRAVEL DOCUMENT: I SOLEMNLY SWEAR that the attached photograph is mine, that the statements made on this application form are true and that the attached supporting documents are authentic. ______________________________________________ SIGNATURE OF APPLICANT IMPORTANT: IF APPLICANT IS UNABLE TO APPLY IN PERSON, THIS FORM SHALL BE NOTARIZED. SUBSCRIBED AND SWORN to before me this ____ day of ______________ 20____ in ___________________________ ________________________________ NOTARY PUBLIC SEAL OF NOTARY PUBLIC .
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