Petition Form for Retention / Re-acquisition of Philippine Citizenship Under R.A. 9225



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:

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;

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 _________________________________;

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):

I surrender for cancellation my original Alien Certificate of Registration (ACR)
no. ________________________ and/or Immigrant Certificate of Residence/Certificate of Residence for Temporary Visitors (ICR/CRTV) no. ____________________________________;

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

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

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(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 Philippine Citizenship under Republic Act No. 9225 be GRANTED.

__________________________________________
Signature over Printed Name

________________________________________
Date [ DD-MM-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.

___________________________________________
Applicant’s Signature over Printed Name