integrated bar of the philippines lawyers id form.pdf · 2020-06-29 · integrated bar of the...

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 | info@ibp.ph

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 ibpaccounting@yahoo.com and ibprecords.id@gmail.com, please do not forget to attach your 2x2" ID photo in image format(e.g. .jpg or .png).

__________________________Signature over printed name