7/31/2019 form_dual(10132010)

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BI FORM: MCL-08-01

Republic of the PhilippinesDepartment of Justice

BUREAU OF IMMIGRATIONIntramuros, Manila

CRR No. ______________ In re: Petition for Re-acquisition and/or 

Retention of Philippine Citizenship u

nder Republic Act No. 9225x----------------------------------------------------------x(Note: Indicate “N/A” if not applicable. Do not leaveany space blank. Print all information LEGIBLY.

Petitions not properly accomplished will not be acted upon.)

I, (Full name of petitioner) FLORENCIO ABEDANIA DULAY , alsoknown as (a.k.a) N/A , of legal age, single/married, a citizenof United States of America and a resident of  

 _________________________________ with contact no. _________________,after being sworn to in accordance with law, hereby declares under oath that:

1. I am a former natural-born Philippine citizen, born on May 29, 1940 atBaguio City, Philippines to (Father’s Name) _______________________,(Father’s citizenship at the time of petitioner’s birth) Filipino citizen, and(Mother’s Name) ______________________________, (Mother’s citizenship at the time of petitioner’s birth) Filipino citizen;

2. I lost my Philippine citizenship where I became a citizen of United States of 

America on ______________. Presently, I became a holder of  ______________________ passport with No. ________________ issued on _______________ at ____________________;

3. I took my oath of allegiance to the Republic of the Philippines on ____________________ at __________________________;

4. (If petitioner is registered alien with the Bureau of Immigration [BI] ) I am aholder of Alien Certificate of Registration (ACR) No. N/A andImmigrant Certificate of Residence/Certificate of Residence for TemporaryVisitors (ICR/CRTV) No. N/A ;

5. (If with Dependent[s] ) Included in this petition is/are my unmarriedchild/children below eighteen (18) years old, namely: 

Name Relationship Date of Birth Age

 _____________________________ _________________ ________________________ 

 _____________________________ ________________ ________________________ 

 _____________________________ ________________ ________________________ 

(Note: Kindly accomplish BI BORM: MCL-08-02 (Supplement) for each dependent to beattached to this petition)

6. I am freely and voluntarily filing this petition to reacquire my Philippinecitizenship knowing fully well its concomitant rights and obligations;

7. This petition with the BI is being filed in accordance with Republic Act No.9225 and it’s implementing rules and regulations.

, premises considered, it is most respectfully prayed

that this petition for Re-acquisition and/or Retention of Philippine Citizenshipunder Republic Act No. 9225 be GRANTED .

 __________________________________ (Signature over printed name of the

Petitioner )

 

BAR CODE

Passport size colored

photo over royal bluebackground