Embed Size (px)
Citation preview
Integrated Bar of the PhilippinesIBP Lawyers ID Form_v062020
IBP Building, No.15 Doña Julia Vargas Avenue, Ortigas Center, Pasig City, Philippines 1600 +63 (02) 631-3018 | +63 (02) 634-4696 | [email protected]
IBP LAWYERS ID FORM (Please write in capital letters)IBP CHAPTER ROLL NUMBER LIFETIME MEMBER NUMBER
SURNAME FIRST NAME MIDDLE NAME
SEX CIVIL STATUS AGE DATE OF BIRTH PLACE OF BIRTH
RESIDENCE ADDRESS MOBILE NUMBER (enter 10-digit number)
e.g. 9151234567
OCCUPATION/EMPLOYMENT
FIELD OF SPECIALIZATION EMAIL ADDRESS
LAW SCHOOL YEAR ADMITTED TO BAR
ID PHOTO SIGNATURE PAYMENT DETAILS
I.D. OR. NO.
DATE:
ASSESSED BY:
AUTHORIZATION FOR DELIVERY BY COURIER: AUTHORIZATION FOR PICK-UP:
I hereby authorize the IBP National Records Office to deliver the requested IBP ID to my mailing address indicated below via LBC or any other courier:
Mailing Address:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_______________________________
Signature of Applicant
I hereby authorize the IBP National Records Office to release the requested IBP ID to:
______________________________
Signature of Applicant
F M
________________________________________ (Name of Authorized Representative)
(please attach in the email the scanned copy of ID of Authorized Representative upon submission of this form)
Upon submission of this form via email to [email protected] and [email protected], please do not forget to attach your 2x2" ID photo in image format(e.g. .jpg or .png).
__________________________Signature over printed name
