Hybrid Claims Plaintiff Personal Information Sheet

A B C D E F G H I J K L M N O P
OLD (NEW 2018) COMPLETE NAME First Contract at Holland America Line MONETARY CONTRIBUTION PERSONAL CONTACT INFORMATION
HAL EMP ID# HAL EMP ID# Surname Given name Middle name Date of Birth Departure (PH) Arrival (PH) Embarkation Disembarkation Function Basic Monthly To fund the preparation and Contact Number(s) Email Address Home Address
Salary submission of this brief

33906 RAFALES BALTAZAR AGBAN 1971/02/13 2000/09/02 2001/08/12 2000/09/03 2001/08/10 Tailor $687.00 ₱40,000.00 Home: 083-877-6217 baltazar_rafales@live.com; Daffodil St. Purok Cagasan, Brgy.
Mobile: 0927-882-5327 justice4seafarers@yahoo.com.ph; or Poblacion, Polomolok, South
Mobile: 0999-983-5621 justice4seafarersandofws@gmail.com Cotabato, 9504 Philippines
 Hybrid Claims Plaintiff Personal Information Sheet
A B C D E F G H I J K L M N O P
OLD (NEW 2018) COMPLETE NAME First Contract at Holland America Line MONETARY CONTRIBUTION PERSONAL CONTACT INFORMATION
HAL EMP ID# HAL EMP ID# Surname Given name Middle name Date of Birth Departure (PH) Arrival (PH) Embarkation Disembarkation Function Basic Monthly To fund the preparation and Contact Number(s) Email Address Home Address
Salary submission of this brief

46225 75723 AYALA ROMMEL MONTEHERMOSO 1970/11/05 2002/10/03 2003/09/16 2002/10/05 2003/09/15 MACHINIST $290.97 ₱16,000.00 HOME: 327-1131 MOBILE: rommelayala0570@yahoo.com Brgy. Maninila, Miag-ao , Iloilo , 5023
09495904063 MOBILE: Philippines
09217483966