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Ofw Information Sheet

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THIS FORM IS NOT FOR SALE FM-MPC-OIS-D01

REPUBLIC OF THE PHILIPPINES


DEPARTMENT OF LABOR AND EMPLOYMENT
OVERSEAS WORKERS WELFARE ADMINISTRATION

Please fill-out this form legibly. FOR OWWA USE ONLY:


LAST PAYMENT OF OWWA CONTRIBUTION

OFW INFORMATION SHEET OR Number: ______________________________

OR Date: _________________________________

Validity: _________________________________

13 NOVEMBER 2017
Date:______________________ Verified by: _______________________________

PERSONAL DATA
UMALI JAN KRISTOFFER AGUILAR
Last Name First Name Name Ext. (e.g. Jr., III) Middle Name

68 MOTHER IGNACIA AVENUE


Philippine Address:
House No. Lot No. Block No. Phase No. Street Subdivision
PALIGSAHAN QUEZON METRO MANILA 1106
Barangay Municipality/City Province Zipcode
+65 81232085
Contact No.: ______________________ umalijan@gmail.com
E-mail Address: ___________________________ EC7315052
Passport No.: ______________________

Birthdate: 12 MALE
12 1985 Sex: ___________________
___/____/____ Religion: ROMAN CATHOLIC Civil Status: _______________________
__________________ SINGLE

Highest Educational Attainment: BACHELOR ARCHITECTURE


OF SCIENCE DEGREE Course: _________________________________________
________________________________

CONTRACT PARTICULARS
EXCLUSIVE DESIGN CONSTRUCTION PTE LTD
Name of Company/Employer: ___________________________________________________________________________________
08 JALAN KILANG BARAT #01-04 CENTRAL LINK S159351
Address: ____________________________________________________________________________________________________

64830420
Tel No.: _______________________ SINGAPORE
Jobsite/Country:_______________________________________________________________
ARCHITECTURAL
COORDINATOR
Position: _______________________ SGD 2600.00
Monthly Salary/Currency: _____________________ 1 YEAR
Contract Duration: __________________

Name of Agency (if applicable): __________________________________________________________________________________

LEGAL BENEFICIARIES/QUALIFIED DEPENDENTS

Name Relationship Date of Birth Address Contact No./E-mail Address


68 MOTHER IGNACIA
DR JOANNE KATHERINE UMALI______________
__________________________ SISTER 09/01/1982
_____________ AVE QUEZON CITY
___________________________ 4116866 / 3716952
____________________
68 MOTHER IGNACIA
DR LAWRENCE KERWIN UMALI______________
__________________________ BROTHER 23/09/1978
_____________ AVE QUEZON CITY
___________________________ 4116866 / 3716952
____________________
68 MOTHER IGNACIA
FLORENCIA LYNN UMALI MOTHER 23/02/1952 4116866 / 3716952
__________________________ ______________ _____________ AVE QUEZON CITY
___________________________ ____________________
ERNESTO UMALI FATHER 30/11/1953 68 MOTHER IGNACIA 4116866 / 3716952
AVE QUEZON CITY
I hereby certify that the above information is true and correct.

Signature of Worker

OWWA Center, 7th St. cor. F.B. Harrison, Pasay City 1300, Philippines . Tel No. 891-7601 to 24 Fax: 804-0638
24/7 Operation Center - Hotlines: 551-6641; 551-1560 . Website: www.owwa.gov.ph
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