soot Pine = unm a AA is G = mera fiat Oem PEA mete 2 aa — BALIK-MANGGAGAWA INFORMATION SHEET Seine Appointment Date: May 31, 2017 10:00 AM eres aeeet Processing Site: Region 4A (Calamba) ieee FERNALD asic ARIEL uinaroc iastNare Festhone Tan eae Ti amo P2952998A__November 28, 1976 Malar MALE WIDOWED Passport Bh Dao Bri Pace Sen visi San juan San Juan Malvar BATANGAS Fae Adios Pippo ss Paps AD 09480074174 anne22_gega@yahoo.com ‘TelephonelCelphone No, E-mail Adsress Mother's Full Maiden Name: Linatoc Adelia Paran Last Name First Name Middle Name Name of Spouse (If married) Last Name Fist Name Middle Name "CONTRACT PARTICULARS OF OFW RF Celada Name of Companyimployer 17 Regina Giovanna Milano ITALY ‘Address of Employer Country ole 1000.00 EUR Tel. NoJFax NoJE-Mall Address Salary / Currency| operator 12 months Postion Contract Duration April 18, 2017 April 19, 2017 Last Deployment Date Last Artval Date LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS Complete Name Sex Relationship of OFW to Dependents, Date of Birth Rommel Eat tasico MALE SON July 18, 2002 Fon Aueltasico MALE ‘SON January 17, 2004 Raymond paul Tasico MALE ‘SON ‘uly 07, 2003) Ryzee Mie! Tasico FEMALE DAUGHTER February 07, 2008 Ihr cory ta he above statements ew tue and cone Control Number: 2202702612 hitpuiwwu.bmerline phiecsiptlppairtmer3b0"fetddbed500b57200597243154 Worker's Signature Over Printed Name w202017 hitpuiwwu.bmerline phiecsiptlppairtmer3b0"fetddbed500b57200597243154 Printing 22