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    Poea Info Sheet

    Uploaded by

    Ilah Nicole Quimson
    The document is a request form for verification or certification of OFW records from the Philippine Department of Migrant Workers. It requests personal information from the applicant such as name, contact details, birthdate, jobsite, year of records needed, and purpose of the request. The applicant signs to certify that the records will only be used for the stated purpose. The bottom section is for government use to record documents presented, records retrieved, type of records released, and processing details.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Poea Info Sheet

    Uploaded by

    Ilah Nicole Quimson
    427 views1 page
    The document is a request form for verification or certification of OFW records from the Philippine Department of Migrant Workers. It requests personal information from the applicant such as name, contact details, birthdate, jobsite, year of records needed, and purpose of the request. The applicant signs to certify that the records will only be used for the stated purpose. The bottom section is for government use to record documents presented, records retrieved, type of records released, and processing details.

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    poea info sheet

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    The document is a request form for verification or certification of OFW records from the Philippine Department of Migrant Workers. It requests personal information from the applicant such as name, contact details, birthdate, jobsite, year of records needed, and purpose of the request. The applicant signs to certify that the records will only be used for the stated purpose. The bottom section is for government use to record documents presented, records retrieved, type of records released, and processing details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    427 views1 page

    Poea Info Sheet

    Uploaded by

    Ilah Nicole Quimson
    The document is a request form for verification or certification of OFW records from the Philippine Department of Migrant Workers. It requests personal information from the applicant such as name, contact details, birthdate, jobsite, year of records needed, and purpose of the request. The applicant signs to certify that the records will only be used for the stated purpose. The bottom section is for government use to record documents presented, records retrieved, type of records released, and processing details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    SECURING OFW RECORD IS FREE OF CHARGE

    REPUBLIC OF THE PHILIPPINES Appoint ment Reference No. (ARN):


    Department of Migrant Workers 778251
    Blas F. Ople Building, Ortigas Avenue cor. EDSA, Mandaluyong City 1501 Branch Office: DMW Main - Ort igas
    Appoint ment Dat e: December 27, 2023
    Appoint ment Time: 11:00 AM

    REQUEST FOR VERIFICATION / CERTIFICATION OF OFW RECORDS


    PERSONAL INFORMATION
    NAVARRO GERNALYN QUIMSON
    LAST NAME (APELYIDO ) FIRST NAME (PANG ALAN) MIDDLE NAME (G ITNANG APELYIDO )
    (MAIDEN NAME FOR FEMALE - KUNG DALAGA PA UMALIS)

    QUIMSON GERNALYN DISAL


    LAST NAME (APELYIDO ) FIRST NAME (PANG ALAN) MIDDLE NAME (G ITNANG APELYIDO )

    09812889508 07/16/1989 PHILIPPINES


    CELLPHO NE NUMBER BIRTHDATE (MO NTH/DAY/YEAR) JO BSITE
    AG ENCY (AHENSYA NA NAG PA-ALIS)
    2012 2012 LB
    YEAR O F RECO RDS NEEDED WO RKER CATEG O RY

    MODE OF DEPLOYMENT (PAANO NAKAALIS)


    AGENCY HIRED DIRECT HIRED BALIK-MANGGAGAWA OT HERS

    PURPOSE OF REQUEST (SAAN GAGAMIT IN ANG KINUKUHANG RECORD)


    EMPLOYMENT ASSISTANCE REQUIREMENT APPLICAT ION OT HERS
    NEW APPLICAT ION BURIAL / INSURANCE DFA VISA OT HERS
    RET URNING T O REPAT RIAT ION T ESDA REDUCED T RAVEL T AX (RT T )
    SAME EMPLOYER
    WHEREABOUT S OWWA PROGRAM LOAN
    LEGAL
    (SUPPORT /COMPLAINT /CASE
    FILING)

    FOR THE AUTHORIZED REPRESENTATIVE (Ang kumukuha ng Record ay HINDI MISMONG OFW)
    LAST NAME (APELYIDO) FIRST NAME (PANGALAN) MIDDLE NAME (GIT NANG APELYIDO)
    RELAT IONSHIP TO OFW
    SPOUSE (ASAWA) SIBLING (KAPAT ID) PARENT (MAGULANG) CHILD (ANAK) RELAT IVE (KAMAG-ANAK)

    This is t o cert ify t hat t he OFW record/s being request ed shall be used ONLY for t he purpose st at ed above.

    GERNALYN QUIMSON NAVARRO


    SIGNAT URE OVER PRINT ED NAME
    (Please do not forget to sign before submiting)

    <<<<<<<<<< DO NOT FILL OUT THIS PORTION: FOR DMW - GSD PERSONNEL ONLY >>>>>>>>>>
    DOCUMENTS PRESENTED ACTION TAKEN (YEAR)
    PASSPORT | UMID | SSS | NBI | VOT ERS ID '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15
    PHILHEALT H | PAGIBIG | PRC | POST AL ID | LT O MARRIAGE CONT RACT '16 '17 '18 '19 '20 '21 '22 '23 '24 '25 '26
    BIRT H CERT IFICAT E SPA / AUT HORIZAT ION
    NUMBER OF RECORDS RETRIEVED / PRINTED
    LET T ER REQUEST _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 01 02 03 04 05 06 07 08 09 10 11 12 13 14
    OT HERS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15 16 17 18 19 20 21 22 23 24 25 26
    OFW RECORD RELEASED
    PRINT-OUT (20 Mins .) DIGIT AL IMAGE (25 Mins .) CERT IFIED COPY (8 Hrs .) CERT IFICAT E OF NO RECORD (25 Mins .)
    ENDORSED / WRIT T EN REQUEST (15 Days )

    RECEIVED EVALUATED & VERIFIED BY REVIEWED & APPROVED BY RELEASING


    RECEIVED / ACKNOWLEDGED BY

    TIME INITIAL TIME INITIAL TIME


    SIGNATURE TIME
    TOTAL PCT: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Wit hin PCT More t han PCT

    REMARKS: REASON IF TARGET PCT IS NOT ACHIEVED


    Server Error Printer Error Photocopy ID / Requirements Others _________________________________

    2023-12-22 08:57:420

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