MARITIME ACADEMY OF ASIA AND THE PACIFIC CENTER FOR ADVANCED MARITIME STUDIES Associated Marine Officers' and Seamen's Union of the Philippines - PTGWO-ITF Kamaya Point, Alas-asin, Mariveles, 2105 Bataan, Philippines

APPLICATION FOR STUDENT IDENTIFICATION CARD

F-029 Issue 0 Revision 1 October 01, 2018

Approved by:

C/E RODOLFO D. PAISO, MSBM

AVP for Post-Graduate/Executive Director

Date: _______________________

Reviewed by:

___________________________

Dean, Center for Advanced Maritime Studies

Date: _______________________

Received by:

_______________________________

Signature over Printed Name Date: ____________________

This application shall not be acted upon unless the following information are received by the Admission Office of the Center for Advanced Maritime Studies, Maritime Academy of Asia and the Pacific, Mariveles, Bataan.

1. Correctly and completely accomplished Application for Student Identification Card.

2. One (1) recent 1 ½” x 2” Passport Size Photo with plain white background. 3. For signature: Please use 1.0 needle point pen.

I further affirm that all information supplied herein are

complete and accurate. I am aware that any or all of the

information furnished in this application may be checked

and that withholding or giving false information will

make me ineligible for student identification card.

Student Signature: Please use 1.0 needle point pen.

Recently taken Passport Size Photo

with Name Tag (1 1/2” x 2”)

Computer generated

or photocopied picture

is not acceptable

ID Number

Needed Information Remarks

Complete Name (LN, FN, MD)

Academic Program

Maritime Rank

Date of Birth

Religion

Complete Address

Contact Number

Blood Type

SSS Number

HDMF Number

TIN

Philhealth Number

In Case of Emergency, pls. contact: