UMID ID Form is an online platform that allows citizens of the United States to apply for a U.S. visa. The process is simple and user-friendly, and can be completed in minutes. With Umid Id Form, you'll have everything you need to get your application started, including step-by-step instructions and help from our team of experts. Plus, there's no need to worry about your personal information; all data is encrypted and secure.
You can definitely find it beneficial to know how much time you will need to prepare this umid id form and how lengthy the form is.
| Question | Answer |
|---|---|
| Form Name | Umid Id Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | umid, how to apply umid id online, umid id online registration 2020, umid id requirements |
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Republic of the Philippines |
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UNIFIED |
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 |
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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) |
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MAIDEN NAME |
(LAST NAME) |
(FIRST NAME) |
(MIDDLE NAME) |
(SUFFIX) |
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(IF MARRIED FEMALE) |
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PART II - FACTS OF BIRTH |
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2. |
DATE OF BIRTH (MMDDYYYY) |
3. PLACE OF BIRTH |
(CITY/MUNICIPALITY) (PROVINCE/STATE) |
(COUNTRY, If born outside the Philippines) |
4. SEX |
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MALE |
FEMALE |
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5a. |
FATHER'S NAME |
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(LAST NAME) |
(FIRST NAME) |
(MIDDLE NAME) |
(SUFFIX) |
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5b. |
MOTHER'S MAIDEN NAME |
(LAST NAME) |
(FIRST NAME) |
(MIDDLE NAME) |
(SUFFIX) |
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PART III - DEMOGRAPHIC DATA |
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6. |
HOME ADDRESS |
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(RM./FLR./UNIT NO. & BLDG. NAME) |
(HOUSE/LOT & BLK. NO.) |
(STREET NAME) |
(SUBDIVISION) |
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(BARANGAY/DISTRICT/LOCALITY)(CITY/MUNICIPALITY)(PROVINCE/STATE)
ZIP CODE
COUNTRY CODE
7. |
MARITAL STATUS |
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SINGLE |
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MARRIED |
WIDOWED |
DIVORCED/ANNULED |
LEGALLY SEPARATED |
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8. |
TAX IDENTIFICATION NUMBER |
9. HEIGHT (IN CENTIMETERS) |
10. WEIGHT (IN KILOGRAMS) |
11. DISTINGUISHING FEATURE(S) |
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(IF ANY) |
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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 |
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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) |
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PART VI - FOR SSS USE ONLY
IDENTIFICATION/DOCUMENT/S PRESENTED
REMARKS
SCREENED BY |
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DATA CAPTURED BY |
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SIGNATURE OVER PRINTED NAME |
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DATE & TIME |
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BRANCH |
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SIGNATURE OVER PRINTED NAME |
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DATE & TIME |
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Perforate |
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Republic of the Philippines |
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UNIFIED
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: |
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Driver's License |
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Professional Regulation Commission (PRC) card |
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Passport |
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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:
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Postal ID |
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Marriage Contract |
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▪ School or Company ID |
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NBI Clearance |
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▪ Taxpayer's Identification Number (TIN) card |
▪ |
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▪ Membership Card issued by private companies |
▪ Permit to Carry Firearms issued by the Firearms & Explosive Unit of PNP |
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▪ Overseas Worker Welfare Administration Card |
▪ PHIC Member's Data Record |
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▪ |
Senior Citizen Card |
▪ |
Police Clearance |
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▪ Voter's Identification Card/Affidavit/Certificate of Registration |
▪ Seafarer's Registration Certificate issued by the Philippine Overseas |
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ATM card |
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Employment Authority (POEA) |
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with cardholder's name |
▪ Temporary License issued by Land Transportation Office (LTO) |
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with certification from bank, if without name |
▪ Transcript of School Records |
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Credit card |
▪ Alien Certificate of Registration |
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▪ Fisherman's Card issued by the Bureau of Fisheries and |
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Bank Account Passbook |
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Aquatic Resources (BFAR) |
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Certificate from: |
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▪ GSIS Card/Member's Record/Certificate of Membership |
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Office of the Southern/Northern Cultural Communities |
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▪ Health or Medical Card |
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Office of Muslim Affairs |
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▪ ID Card issued by LGUs (e.g. Barangay/ Municipal/City) |
▪ Certificate of Licensure/Qualification Documents/Seafarer's ID & Record |
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▪ ID Card issued by professional association recognized by PRC |
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Book from Maritime Industry Authority |
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Permanent Residency ID |
▪ Certificate of Naturalization from the Bureau of Immigration |
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Birth Certificate |
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Life Insurance Policy |
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Baptismal Certificate |
▪ Birth/Baptismal certificate of child/ren or its equivalent |
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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 |
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1 in = 2.54 cm |
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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.