Kyle
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This document is an information sheet for overseas Filipino workers (OFWs) containing their personal details such as name, address, birthdate, civil status, passport information, as well as contract details including employer name, job position, salary, and duration. It collects information on the worker's beneficiaries who will receive welfare benefits from OWWA. The worker also provides their PhilHealth membership and latest payment details. The form is to be filled out by the OFW and submitted to relevant Philippine government agencies POEA, OWWA, and PhilHealth to update records and process membership contributions and benefits for overseas workers.
Kyle
- 1. PHILIPPINE OVERSEAS EMPLOYMENT ADMINISTRATION OVERSEAS WORKERS WELFARE ADMINISTRATION PHILIPPINE HEALTH INSURANCE CORPORATION FM-POEA O2-GP-07 Effectivity date : April 8, 2005 OFW INFORMATION SHEET PERSONAL DATA Change/s (if any) Name _________________________________ _______________________________ ______________________________ ___________________________________ Family Name (Apelyido) First Name (Pangalan) Middle Name (G. Apelyido) ___________________________________ Address in the Phils (Tirahan): _________________________________________________________________________ ___________________________________ __________________________________ Birth date: ____ / ____ / _____ Sex: M F Civil Status: Single Widowed __________________________________ MM DD YYYY __________________________________ Married Separated __________________________________ Passport No: ___________________________ Highest Educational Attainment: __________________________ __________________________________ Name of Spouse (if married): ______________________________________ Mothers Full Maiden Name: _____________________________________________ Legal Beneficiaries (Mga tatanggap ng benepisyo sa OWWA) : Name Relationship Address ________________________________________________________ ________________________ ________________________________________________________ ________________________________________________________ ________________________ ________________________________________________________ ________________________________________________________ ________________________ ________________________________________________________ ALLOTTEE (Itinalaga na padadalhan ng bahagi ng sahod ng OFW): __________________________________________________________________ ________________________________________________________________________ CONTRACT PARTICULARS OF OFW Change/s (if any) Name of Principal / Company / Employer: ________________________________________________________________ _________________________________ Address: ______________________________________________________________________________________________ _________________________________ Jobsite/Country of Destination: _____________________________________ Tel No: ______________________ _________________________________ Position of OFW: ___________________________________ Fax No / Email address: ______________________ _________________________________ Contract Duration ___________ months Monthly Salary: ___________________ Currency: _____________ _________________________________ Last date of arrival of vacationing worker in the Phils: _________________________________________________ _________________________________ Date of scheduled departure / Return of OFW to the jobsite: ___________________________________________ _________________________________ Name of Agency (if applicable): _______________________________________________________________________________________________________________ ___________________________________ __________________________________ Signature of Worker / Approval of Authorized Agency Thumbmark Representative ( if agency-hired) -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (To be filled in by OFW for PHILHEALTH RECORD) Name of Worker: _____________________________________________________________________________________________________________ Family Name (Apelyido) First Name (Pangalan) Middle Name (G. Apelyido) Address in the Philippines (Tirahan) :_____________________________________________________________ Tel No: ______________ Date of Birth: _____ / _____ / ________ Birthplace: ____________________________________________ MM DD YYYY Sex: M F Civil Status: Single Married Widowed Separated Dependents (Mga makikinabang): 20 years old and below for child/ren, 60 years old and above for parents, and Unemployed spouse. Name of Children/Parent/Spouse Sex Relationship of OFW Date of Birth to dependent/s (mm/dd/yyyy) _______________________________________________________________ ______ _____________________ __________________ _______________________________________________________________ ______ _____________________ __________________ _______________________________________________________________ ______ _____________________ __________________ _______________________________________________________________ ______ _____________________ __________________ _______________________________________________________________ ______ _____________________ __________________ _______________________________________________________________ ______ _____________________ __________________ _______________________________________________________________ ______ _____________________ __________________ I hereby certify that the above statements are true and correct. (Ako ay nagpapatunay na ang nasa itaas na pahayag ay totoo at tama). _________________________________ Signature of Worker LASTEST PAYMENT: DATE: ______ 1. OWWA MEMBERSHIP: _________________ 2. PHILHEALTH/ MEDICARE: ___________________ DO NOT WRITE ON THIS SPACE (For POEA, OWWA, Philhealth Use Only) CG No: __________________________ RFP No: __________________________ Assessment No: ____________________ Assessed Amount : POEA: _________________________ OWWA: _________________________ PHILHEALTH: ___________________ OFW E-Card / ID No: