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DOLE AKAP Application Form

Akap form

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Argen Vill
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24 views

DOLE AKAP Application Form

Akap form

Uploaded by

Argen Vill
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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POLO-MADRID DOLE AKAP FORM NO.

2020- _________

EMBASSY OF THE PHILIPPINES


PHILIPPINE OVERSEAS LABOR OFFICE
Madrid, Spain

FINANCIAL ASSISTANCE FOR DISPLACED LANDBASED AND SEABASED FILIPINO WORKERS


AFFECTED BY THE CORONA VIRUS DISEASE (COVID-2019)
“DOLE-AKAP for OFWs”

APPLICATION FORM*
*This form is not for sale.
Please supply all required information. Misrepresentation 1, false statement or fraud in this application or in any supporting
document is ground for denial of the application.

A OFW DATA

Name of OFW: ________________________ ____________________________ _______________________ _______


(Last Name) (First Name) (Middle Name) (Suffix)

Birthdate(mm/dd/yyyy): ____/_____/_______ Philippine Passport No: ______________________ Expiry Date: ______________________

Contact No.: ___________________ E-mail Address: __________________________ FACEBOOK Account: __________________

Address Abroad : ________________________________________________________________________________________________

Do you have a residence/work permit? Yes No If YES, Residence/work permit card number:_______________________

What is your status in the host country? Permanent resident Temporary worker Family petition Undocumented

Enrolled in Social Security?: Yes No With Yellow Card? Yes No If YES, Number: _________________________

Active OWWA member?: Yes No Are you currently in the job site? Yes No

B EMPLOYMENT DETAILS

Job Description: ______________________________ Company/Employer: _____________________________________________________

Address of Employer: __________________________________________________________ Contact No.: _____________________________

C DISPLACEMENT DETAILS

Job Displacement due to COVID19? Yes No If YES, type of displacement: Terminated No work, no pay Since ____________2020

Are you receiving your salary/financial assistance from Employer? Yes No

Are you receiving or eligible to apply/receive financial support/assistance from the host government such as unemployment benefit, special
assistance/ayuda for domestic workers, temporary work suspension benefit or ERTE, etc.? Yes No

Have you received any financial assistance from OWWA due to COVID-19? Yes No

D DOCUMENTS SUBMITTED

Photocopy of datapage of Valid Philippine Passport


d Proof of Overseas Employment (e.g., valid POLO verified Employment Contract/ Certificate of Employment or
OEC or Pay Slip)
Copy of Latest Employment History from Social Security/Vida Laboral or equivalent document
Proof of loss of employment on account of COVID19 (Notice of Termination, Certification from Employer, etc)
Copy of worker´s residence card (e.g.TIE) or if without, copy of Yellow Card
Copy of OWWA receipt showing active membership

CERTIFICATION AND CONSENT


E
I hereby certify that the information and documents given/submitted herein are true, valid, and correct to the best of my knowledge.

By applying, I consent to the collection, generation, use, processing, storage and retention of my personal data by the Department of Labor
and Employment (DOLE), Overseas Workers Welfare Administration (OWWA), and Philippine Embassy/POLO-Madrid for the purpose of my application
for FINANCIAL ASSISTANCE FOR DISPLACED LANDBASED AND SEABASED FILIPINO WORKERS AFFECTED BY THE CORONA VIRUS
DISEASE (COVID-2019) “DOLE-AKAP for OFWs.” Further, I also give my consent to DOLE, OWWA and other relevant government agencies to
contact me for further verification and validation.

___________________________ _______________________________________________
Date of Application Signature of Applicant

1
Misrepresentation of facts in this application includes fraudulent misrepresentation, i.e. false statement that has a negative effect in the evaluation of
the application made knowingly, or without belief in its truth, or recklessly whether it is true of false.

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