BALIK-MANGGAGAWA INFORMATION SHEET

Appointment Date: November 20, 2019 01:00 PM

Processing Site: Region 6 (Iloilo)

PERSONAL DATA
 

CALDEA GRACE BALUCAN

Last Name First Name Name Ext. (e.g. Jr.,III) Middle Name

p1377242a April 17, 1976 maigo lanao del norte FEMALE MARRIED
Passport Birth Date Birth Place Sex Civil Status
kalubihan bato Roxas City CAPIZ
Home Address in the Philippines

0914807771 121167642242
SSS Pag-IBIG RTN/MID

09069206167 caldeagrace@gmail.com
Telephone/Cellphone No. E-mail Address

Mother's Full Maiden Name:

balucan anunciacion fuentebella
Last Name First Name Middle Name
Name of Spouse (If married)
caldea rodney magno
Last Name First Name Middle Name

CONTRACT PARTICULARS OF OFW

wadha ahmed kh al-sulaiti

Name of Company/Employer

bldg.2 zone 56, st. 632 ain khalid QATAR

Address of Employer Country

09069206167 / caldeagrace@gmail.com 1500.00 QAR

Tel. No./Fax No./E-Mail Address Salary / Currency
hhw 24 months
Position Contract Duration
May 20, 2017 October 21, 2019
Last Deployment Date Last Arrival Date

LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS

 

Complete Name Sex Relationship of OFW to Dependent/s Date of Birth

rodney caldea MALE SPOUSE November 05, 1978
 
I hereby certify that the above statements are true and correct.

Control Number: C4305349466

Worker's Signature Over Printed Name