7/31/2014
NBI Onli ne Appl icati on
PRINT APPLICATION
B2123040343
REPUBLIC OF THE PHILIPPINES DEPARTMENT DEPARTMENT OF J USTICE NATIONAL BUREAU OF INVESTIGATION
NBI CLEARANCE APPLICATION FORM
APPLIC ANT TYP E RENEWAL
1. ID PRESENTED PASSPORT PASSPORT EB1907710
2. PURPOSE TYPE LOCAL
3. PURPOSE APPLICATION LOC AL EMPLOYMENT EMPLOYMENT
BASIC INFORMATION 5. FAMILY NAME BIASBAS
6. HUSBAND FAMILY NAME (FOR MARRIED WOMAN ONLY)
7. GIVEN NAME CHRISTOPHER
8. MIDDLE NAME BINAS
9. NICKNAME CHRIS
10. OTHER NAME/ALSO KNOW AS
11. DATE OF BIRTH 07/15/1984
12. BIRTH PLACE LUCENA, QUEZON
13. CITIZENSHIP FILIPINO
14. GENDER MALE
16. SPOUSE MARQUILIN P. BIASBAS
17. BIRTH PLACE MALANDAY, MARIKINA
15. CIVI L STATUS STATUS MARRIED
18. PRESENT ADDRESS L-223 HAMPTON GARDENS, 100 C. RAYMUNDO AVE., MAYBUNGA PASIG CITY 19. CONTACT NUMBER 09285202373
20. EMAIL ADDRESS
[email protected]
21. IDENTIFYING MARKS MARKS
24. COMPLEXION BROWN
25. RELIGION ROMAN ROMAN CATHOL CATHOL IC
ADDITIONAL INFORMATION 22. HEIGHT 172 26. ED UCATIONAL ATTAINMENT ATTAINMENT COLLEGE GRADUATE
23. WEIGHT 65
27. OCCUPATION IT SPECIALIST
PAREN PAREN TS IN FOR MATION 28. NAME OF FATHER JOSE M. BIASBAS
29. FATHER BIRTH PLACE SAMPALOC, MANILA
30. NAME OF MOTHER AMELIA R. BINAS
31. MOTHER BIRTH PLACE SAMPALOC, MANILA
FOR ALIEN APPLICANT'S ONLY 32. FOREIGN NAME
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33. ADDRESS ABROAD 34. PASSPORT NUMBER
35. DATE ISSUED -
36. PLACE ISSUED -
37. ACR NUMBER -
38. DATE ISSUED -
39. PLACE ISSUED
I certify that I have read and understood all the questions set forth in this application and answer I have furnished on this form are true and correct to the best acknowledge and beli ef. I understand that any false or misleading statement is FALSIFICATION PUNISHABLE UNDER ARTICLE 171 & 172 OR REVISED PENAL CODE
________________________________
________________________________
36. DATE
37. SIGNATURE
© 2014 All Rights Reserved
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