Revised DPRM Form 1B-2007

PHILIPPINE NATIONAL POLICE

ID APPLICATION FORM
(PNP Dependents)
Fill in all applicable spaces. Mark all appropriate boxes with ‘x’ Form Control No.
Status of PNP Personnel: Purpose of Application:
CATEGORY: Active Retired New Renewal/Update Replacement
Deceased
REQUIREMENTS:
DEPENDENT DATA 1. APPLICATION FOPRM ENDORSED BY
ADMIN/PERS OFFICER
APPLICANT’S 2. CERTIFICATE OF LEGAL BENEFICIARIES
NAME: _________________ ________________ ______________ _______ (CLB) FROM RMD.
Last First Middle Qualifier Without CLB from RMD, please
Submit the following:
BIRTHDATE a. Affidavit of Confirmation;
(MM/DD/YY): b. Certificate of Legal
Beneficiaries from Unit;
HOME ADDRESS: c .NSO copy of Birth Certificate
(Children); and
d. NSO copy of Marriage
RELATIONSHIP: Certificate (husband/wife of
WEIGHT: (in Kg)
HEIGHT: (in Cm) PNP personnel)
3. PHOTOCOPY OF PNP ID OF THE SPONSOR.
COLOR OF EYES: COLOR OF HAIR: 4. AFFIDAVIT OF LOSS, If loss.
BLOOD TYPE: RELIGION: 5. NSO copy of DEATH CERTIFICATE, if
deceased PNP member.
TIN: OTHER IDENTIFYING
6. PAYMENT OF 60.00 PESOS FOR THE
DATA: DEPENDENT ID CARD.
PERSON O BE NOTIFIED IN CASE OF EMERGENCY: PROCEDURES IN THE APPLICATION
AND PROCESSING OF ID CARDs:
TEL. NO. OF PERSON TO BE NOTIFIED:
1. SUBMIT ACCOMPLISHED APPLICATION
FORM & REQUIRED DOCUMENTS TO THE
CHIEF, RPHRDD/ADMIN/PERSONNEL OFFICER
POLICE PERSONNEL DATA FOR THE PREPARATION OF ENDORSEMENT.
DEPENDENT OF: 2. THE APPLICATION TOGETHER WITH ITS
CORRESPONDING ENDORSEMENT
(Name of PNP ________________ ________________ ______________ _______ WILL BE FORWARDED TO THE RECORDS
Personnel) Last First Middle Qualifier MANAGEMENT DIVISION (RMD), DPRM THRU
THEIR LIAISON OFFICER.
3. THE MESSAGE CENTER, RMD WILL LOG
RANK/DESIGNATION: BADGE NUMBER: AND VERIFY THE APPLICATION. IF
COMPLETE/CORRECT, IT WILL BE
PRESENT UNIT (If Retired, Last Unit): FORWARDED TO THE ID SECTION.
4. THE ID SECTION WILL VALIDATE AND
ADDRESS: FORWARD THE APPLICATION TO THE OFFICE
OF THE EXECUTIVE OFFICER, DPRM FOR
Date _____________ APPROVAL & SIGNATURE OF THE ID CARD.
5. THE APPROVED APPLICATION WILL BE
RETURNED TO THE ID SECTION.
I declare, under the penalties of perjury, that this ID Application form has been 6. THE ID CARD WILL BE RETURNED TO THE
accomplished in good faith, verified by me, and to the best of my knowledge and MESSAGE CENTER, RMD FOR
belief, is true and correct, pursuant to the provisions of pertinent laws, rules and CONSOLIDATION AND CONSEQUENTLY
WILL BE RELEASED TO THE CONCERNED
regulations of the Republic of the Philippines.
LIAISON OFFICERS.
7. THE LIAISON OFFICERS WILL RETURN
I also authorize the PNP/authorized representative to verify/validate the contents THE ID CARD TO THE CHIEF,
stated herein. (Please affix your signature at the box below) RPHRDD/ADMIN/PERSONNEL OFFICER FOR
DISTRIBUTION TO THE CONCERNED

PERSONNEL

2x2 COLORED PICTURE

WITH
WHITE BACKGROUND

Signature of Applicant (in black pen) Right Thumb Mark

RECOMMENDED BY: PROCESSED BY: APPROVED BY:

(Signature over Printed Name) ACTION CLERK, ID SECTION, RMD, DPRM FOR TDPRM:
CHIEF, RPHRDD/ADMIN/PERS OFFICER REVIEWED BY:
MANUEL RABAGO GAERLAN, CEO VI
Police Senior Superintendent (DSC)
RANK UNIT Chief, Records Management Division