IRD-A-TAC-2016 Transfer, Amendment/Correction Application

BI application form for transfer, amendment/correction

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APPLICATION FOR TRANSFER, AMENDMENT/
CORRECTION/STAMPING
Last Name

Passport Number (Old)

First/Given Name

Passport Number (New)

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

Latest Date of Arrival

Citizenship/Nationality

Status of Admission

Flight Number

Application: [please check]

BIBS No.
Residential/Registered Address in the Philippines

Cancellation of old passport
Loss of previous passport
Amendment/Correction
Failed to stamp (encoded)
Failed to stamp (not encoded)*

Contact Numbers in the Philippines
Landline
Mobile

Others
Email Address

*For failed to check
Reason (explain the absence of arrive/departure stamp):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

_______________________________
Signature over PRINTED NAME of Applicant
or Authorized Representative

IRD STAMP/NOTATION

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

NO DEROGATORY RECORD STAMP

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