8/9/2019 6. AF Petition for Re-Acquisition and or Retention of Phil Citizenship

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BI FORM 2014-01-005 Rev 0 This document may be reproduced and is NOT FOR SALE

PETITION FORM FOR RETENTION/RE-ACQUISITION OF

PHILIPPINE CITIZENSHIP UNDER R.A. 9225

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PETITION

I, ____________________________________________________________________________,

also known as _______________________________________________________, _____ years of age,

male/female, am single/widowed/divorced/annulled/separated/married to _________________________

____________________________. I, a citizen of _________________and resident of _______________

____________________________________________ with contact number ______________________,

after being sworn to in accordance with law, hereby declare under oath that:

1. I am a former natural-born Philippine citizen, born on ___________________________________

at ___________________________to _______________________________________________,

_______________________________citizen by birth/election/marriage/naturalization, who was

married/not married to ___________________________________________________________,

_____________________________citizen by birth/election/marriage/naturalization;

2. I lost my Philippine citizenship when I became a citizen of ________________________________

on _____________________. Presently, I am a holder of a valid ___________________ passport

with number _________________ issued on ___________________ at ____________________;

3. I took my Oath of Allegiance to the Republic of the Philippines on __________________________

at _______________________________;

(If the petitioner is a registered alien with the Bureau of Immigration):

4.

I surrender for cancellation my original Alien Certificate of Registration (ACR)

no. _______________________and/or Immigrant Certificate of Residence/Certificate of Residencefor Temporary Visitors (ICR/CRTV) no. _________________________;

(If with Dependent/s):

5.

Included in this petition is/are my unmarried child/ren below eighteen (18) years of age, namely:

(Please use BI Form 2014-01-006 Rev 0 for each dependent to be attached to this petition.)

WHEREFORE, it is prayed that this petition for

Retention and/or Re-acquisition of PhilippineCitizenship under Republic Act No. 9225 be

GRANTED.

____________________________________________________

Signature over Printed Name

__________________________________________

Date [DD-MMM-YYYY e.g. 01 JAN 1990]

VERIFICATION

I certify under oath that the above statements are true and correct to my own personal knowledge, and based on authentic

documents in my possession.

________________________________________

Applicants Signature over Printed Name

SUBSCRIBED AND SWORN TO before me this ______________ in _______________________, Petitioner personally

appeared and exhibited to me his/her passport with number _____________________ issued on ____________________________

at __________________.

Doc No.: _________

Page No.: ________

Book No.: ________

Series of ________

Name Gender Date of Birth[DD-MMM-YYYY e.g. 01 JAN 1990]

Age

_______________________________________ _______ ________________________ _____

_______________________________________ _______ ________________________ _____

_______________________________________ _______ ________________________ _____

[Name in Philippine Document]

[Fathers name]

[Fathers citizenship at the time of petitioners] birth

[Mothers name]

[Mothers citizenship at the time of petitioners birth]

[DD-MMM-YYYY e.g. 01 JAN 1990]

[DD-MMM-YYYY e.g. 01 JAN 1990]

[DD-MMM-YYYY e.g. 01 JAN 1990]

Attach your 2x2 colored

photographwith white

backgroundusing

permanent glue in the

photograph box.

The photograph must be taken

within the last three (3) months

from the date of application.

A scanned photograph is not

allowed. A photograph of the

applicant wearing eyewear (i.e.

sunglasses, colored contact lenses,

etc.) or headwear is not acceptable.

[Name in foreign passport]

[as appearing in Philippine document]

[at the time of petitioners birth(underline applicable)]

[at the time of thepetitioners birth(underline applicable)]

(underline applicable)