Umid Id Form PDF Details

In the heart of the Philippines' efforts to streamline government services and provide citizens with a unified means of identification, the Unified Multi-Purpose ID (UMID) stands out as a cornerstone. The UMID Card Application Form, effective from July 2013, serves as a critical tool in achieving this integration. Designed for versatility, it caters to a range of needs from initial enrollment to card replacement, encompassing scenarios like the loss of a card, amendments to personal details, or updates to demographic data. The form requires applicants to input their information clearly and accurately in capital letters, using black or blue ink, emphasizing the government's push for legibility and precision in official documents. It outlines the need for details such as the applicant's name, birth facts, demographic data, and a statement of consent for the use of this data within the UMID system—a reflection of the meticulous protocols set to safeguard personal information under Executive Orders 420 and 700. The back of the form provides detailed instructions, ensuring that applicants understand the requirements, including the necessary identification documents for submission, and the proper format for filling out the form to avoid common errors that could delay processing. With its comprehensive approach, the UMID Card Application Form is more than just a document; it is a testament to the Philippine government's commitment to modernizing and simplifying public service delivery for its citizens.

QuestionAnswer
Form NameUmid Id Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameshow to get umid id online 2020, umid id online application, umid, umid id online registration

Form Preview Example

 

Republic of the Philippines

 

UNIFIED MULTI-PURPOSE ID (UMID) CARD

(07-2013)

APPLICATION FORM

THIS FORM IS NOT FOR SALE AND CAN BE REPRODUCED

PLEASE READ THE INSTRUCTIONS AT THE BACK BEFORE FILLING OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK OR

BLUE INK ONLY.

NAME OF AGENCY

SOCIAL SECURITY SYSTEM

COMMON REFERENCE NUMBER (IF ANY)

PURPOSE

INITIAL ENROLLMENT

CARD REPLACEMENT

 

Replacement of Lost Card

Amendment of Facts of Birth

Replacement of Damaged Card

Amendment of Demographic Data

Amendment of Name

Amendment of Authenticating Finger

Others ____________________

__________________________

PART I - NAME

1.

NAME

(LAST NAME)

(FIRST NAME)

(MIDDLE NAME)

(SUFFIX)

 

 

 

 

 

 

 

 

 

MAIDEN NAME

(LAST NAME)

(FIRST NAME)

(MIDDLE NAME)

(SUFFIX)

 

 

(IF MARRIED FEMALE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART II - FACTS OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

DATE OF BIRTH (MMDDYYYY)

3. PLACE OF BIRTH

(CITY/MUNICIPALITY) (PROVINCE/STATE)

(COUNTRY, If born outside the Philippines)

4. SEX

 

 

 

 

 

 

 

 

 

 

 

 

MALE

FEMALE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5a.

FATHER'S NAME

 

 

(LAST NAME)

(FIRST NAME)

(MIDDLE NAME)

(SUFFIX)

 

 

 

 

 

 

 

 

5b.

MOTHER'S MAIDEN NAME

(LAST NAME)

(FIRST NAME)

(MIDDLE NAME)

(SUFFIX)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART III - DEMOGRAPHIC DATA

 

 

 

 

 

 

 

 

 

6.

HOME ADDRESS

 

(RM./FLR./UNIT NO. & BLDG. NAME)

(HOUSE/LOT & BLK. NO.)

(STREET NAME)

(SUBDIVISION)

(BARANGAY/DISTRICT/LOCALITY)(CITY/MUNICIPALITY)(PROVINCE/STATE)

ZIP CODE

COUNTRY CODE

7.

MARITAL STATUS

 

 

 

 

 

 

 

 

 

 

 

SINGLE

 

 

MARRIED

WIDOWED

DIVORCED/ANNULED

LEGALLY SEPARATED

 

 

 

 

 

 

 

 

 

 

 

 

8.

TAX IDENTIFICATION NUMBER

9. HEIGHT (IN CENTIMETERS)

10. WEIGHT (IN KILOGRAMS)

11. DISTINGUISHING FEATURE(S)

 

 

(IF ANY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART IV - STATEMENT OF CONSENT

I declare that I am fully aware that the above data shall be used for securing my Common Reference Number (CRN) for the Unified Multi- Purpose ID (UMID) System or updating my personal data in the CRN Registry. I trust that the above data shall remain confidential, hence, I give my consent that the same data be secured and accessed for subsequent validation, verification and other purpose consistent with the objectives of the UMID System under Executive Order No. (EO) 420 as amended by EO No. 700. I further affirm that all statements/data, which appear in this application form and made by me are true, correct and complete to the best of my knowledge and belief.

PRINTED NAME

SIGNATURE

DATE

SS NUMBER

PART V - OTHER ENROLLEE DATA

TELEPHONE NUMBER (AREA CODE + TEL. NO.)

MOBILE/CELLPHONE NUMBER

E-MAIL ADDRESS

 

 

 

IF YOU ARE A SURVIVING SPOUSE/GUARDIAN/DEPENDENT OF DECEASED/PENSIONER MEMBER, PLEASE INDICATE SS NUMBER/COMMON REFERENCE NUMBER (IF ANY) OF DECEASED/PENSIONER MEMBER BELOW

SS NUMBER/COMMON REFERENCE NUMBER

NAME OF MEMBER

(LAST NAME)

(FIRST NAME)

(MIDDLE NAME)

(SUFFIX)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART VI - FOR SSS USE ONLY

IDENTIFICATION/DOCUMENT/S PRESENTED

REMARKS

SCREENED BY

 

 

 

 

 

DATA CAPTURED BY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OVER PRINTED NAME

 

DATE & TIME

BRANCH

 

SIGNATURE OVER PRINTED NAME

 

DATE & TIME

 

 

 

 

 

 

 

 

 

 

 

 

-------------------------------------------------------------------------------------------------

 

 

Perforate Here-------------------------------------------------------------------------------------------------

 

 

 

 

 

 

 

 

Republic of the Philippines

 

 

 

 

UNIFIED MULTI-PURPOSE ID (UMID) CARD APPLICATION FORM

ACKNOWLEDGEMENT STUB

SS NUMBER/COMMON REFERENCE NUMBER

NAME OF AGENCY

SOCIAL SECURITY SYSTEM

BRANCH

NAME

(LAST NAME)

(FIRST NAME)

(MIDDLE NAME)

(SUFFIX)

SCREENED BY

DATA CAPTURED BY

SIGNATURE OVER PRINTED NAME

DATE & TIME

SIGNATURE OVER PRINTED NAME

DATE & TIME

INSTRUCTIONS

1.This form shall be used in applying for initial or replacement UMID card.

2.Fill out this form in one (1) copy without erasures and alterations.

3.Place a checkmark on the applicable box.

4.Always indicate "N/A" or "Not Applicable", if the required data is not applicable.

5.Present identification document/s.

a. Any one (1) of the following primary documents:

 

 

Driver's License

Professional Regulation Commission (PRC) card

Passport

Seaman's Book

b. In the absence of the primary documents, submit any two (2) of the following secondary documents, one of which with signature and photo:

Postal ID

Marriage Contract

School or Company ID

NBI Clearance

Taxpayer's Identification Number (TIN) card

Pag-IBIG Member's Data Form

Membership Card issued by private companies

Permit to Carry Firearms issued by the Firearms & Explosive Unit of PNP

Overseas Worker Welfare Administration Card

PHIC Member's Data Record

Senior Citizen Card

Police Clearance

Voter's Identification Card/Affidavit/Certificate of Registration

Seafarer's Registration Certificate issued by the Philippine Overseas

ATM card

 

Employment Authority (POEA)

 

-

with cardholder's name

Temporary License issued by Land Transportation Office (LTO)

 

-

with certification from bank, if without name

Transcript of School Records

Credit card

Alien Certificate of Registration

Fisherman's Card issued by the Bureau of Fisheries and

Bank Account Passbook

 

Aquatic Resources (BFAR)

Certificate from:

GSIS Card/Member's Record/Certificate of Membership

 

-

Office of the Southern/Northern Cultural Communities

Health or Medical Card

 

-

Office of Muslim Affairs

ID Card issued by LGUs (e.g. Barangay/ Municipal/City)

Certificate of Licensure/Qualification Documents/Seafarer's ID & Record

ID Card issued by professional association recognized by PRC

 

Book from Maritime Industry Authority

Permanent Residency ID

Certificate of Naturalization from the Bureau of Immigration

Birth Certificate

Life Insurance Policy

Baptismal Certificate

Birth/Baptismal certificate of child/ren or its equivalent

6.Fill out appropriate items in the following format:

a.Items 1, 5a and 5b

Example: Juan Andres Gregorio Toralba III will be entered as:

b.Item 1 (For Married Female)

Example: Anna Maria Dela Cruz Santos at birth and married name is Anna Maria Roman will be entered as:

c.Item 6

Example: 837 Akle St., Barangay Claro, Project 2, Quezon City 1102 will be entered as:

Indicate the permanent address rather than the temporary mailing address. For example, if with permanent residence in the province but working or staying in Metro Manila during weekdays, indicate the provincial address instead of the Metro Manila address.

7.Write the "Height" in centimeters and "Weight" in kilograms.

To convert:

1 ft = 30.38 cm

1 lb = 0.4536 kg

 

1 in = 2.54 cm

 

8.In item 11, limit the distinguishing features to those that can be found on the face such as "mole under the right eye" and "mole or birth mark on the left cheek/forehead".

9.For card replacement, pay the required fee at any SSS branch office/accredited bank/collecting agent and submit this form together with the required document/s and validated Miscellaneous Payment Form or Special Bank Receipt (SBR) with Miscellaneous Payment Form to the nearest SSS branch office.

10.For card replacement due to amendment of data/authenticating finger, submit the previously issued SSS or UMID card.

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umid id empty fields to complete

Complete the a FATHERS NAME, LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX, MALE, FEMALE, b MOTHERS MAIDEN NAME LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX, HOME ADDRESS, RMFLRUNIT NO BLDG NAME, HOUSELOT BLK NO, and STREET NAME field with all the information required by the platform.

Entering details in umid id part 2

Highlight the most essential information on the PRINTED NAME, SIGNATURE, DATE, PART V OTHER ENROLLEE DATA, SS NUMBER, TELEPHONE NUMBER AREA CODE TEL NO, EMAIL ADDRESS, IF YOU ARE A SURVIVING, NAME OF MEMBER, MIDDLE NAME, FIRST NAME, LAST NAME, SUFFIX, IDENTIFICATIONDOCUMENTS PRESENTED, and REMARKS section.

Filling in umid id step 3

The SOCIAL SECURITY SYSTEM, NAME, LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX, SCREENED BY, DATA CAPTURED BY, SIGNATURE OVER PRINTED NAME, DATE TIME, SIGNATURE OVER PRINTED NAME, DATE TIME, Perforate here, RIGHT THUMB, and RIGHT INDEX section is the place to place the rights and obligations of both sides.

Filling out umid id part 4

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