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ofwinformationsheet

The document is an Overseas Workers Welfare Administration (OWWA) information sheet for overseas Filipino workers (OFWs) to fill out with personal and employment details. It includes sections for personal data, contract particulars, and legal beneficiaries. The form is not for sale and is intended for official use only.

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9 views

ofwinformationsheet

The document is an Overseas Workers Welfare Administration (OWWA) information sheet for overseas Filipino workers (OFWs) to fill out with personal and employment details. It includes sections for personal data, contract particulars, and legal beneficiaries. The form is not for sale and is intended for official use only.

Uploaded by

me
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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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: _________________________________

12/01/2023
Date:______________________ Verified by: _______________________________

PERSONAL DATA
MILLAS CLARISSA GONZALES
Last Name First Name Name Ext. (e.g. Jr., III) Middle Name

Philippine Address: Barangay San Antonio Calapan City Oriental Mindoro


House No. Lot No. Block No. Phase No. Street Subdivision
Proper 1
Barangay Municipality/City Province Zipcode
+639279510238
Contact No.: ______________________ P8107739A
[email protected] Passport No.: ______________________
E-mail Address: ___________________________

31 1995
Birthdate: ___/____/____ Female
Sex: ___________________ Catholic
Religion: __________________ Single
Civil Status: _______________________
High School
Highest Educational Attainment: ________________________________ Course: _________________________________________

CONTRACT PARTICULARS
Novell Nassir Adawi
Name of Company/Employer: ___________________________________________________________________________________
Jeddah-Al Faisaliyyah Saudi Arabia
Address: ____________________________________________________________________________________________________
00966545664545
Tel No.: _______________________ Saudi Arabia
Jobsite/Country:_______________________________________________________________
Hr Manager
Position: _______________________ $4,000
Monthly Salary/Currency: _____________________ Contract Duration: __________________

Name of Agency (if applicable): __________________________________________________________________________________

LEGAL BENEFICIARIES/QUALIFIED DEPENDENTS

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


Joseph Serna Millas,
__________________________ ______________ _____________ ___________________________ ____________________
Nicanor Baculo Lalong-isip ______________ _____________ ___________________________ ____________________
__________________________
Nico James Lalong-isip ______________ _____________ ___________________________ ____________________
__________________________

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
REV: 01

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