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BALIK-MANGGAGAWA INFORMATION SHEET

Appointment Date: January 24, 2020 02:00 PM
Processing Site: Singapore

PERSONAL DATA

AGUSTIN SHERWIN BRYAN RUBA

Last Name First Name Name Ext. (e.g. Jr.,III) Middle Name
P5971072A May 30, 1995 SAN JOSE CITY, N.E. MALE SINGLE
Passport Birth Date Birth Place Sex Civil Status
ZONE 2 SANTO TOMAS San Jose City NUEVA ECIJA
Home Address in the Philippines
0241461479 121192142921
SSS Pag-IBIG RTN/MID
+6587413805 sb_agustin@yahoo.com
Telephone/Cellphone No. E-mail Address
Mother's Full Maiden Name:
RUBA EMMARIE BALABA
Last Name First Name Middle Name
Name of Spouse (If married)

Last Name First Name Middle Name

CONTRACT PARTICULARS OF OFW

GROUND INSTRUMENTATION AND ENGINEERING PTE. LTD.

Name of Company/Employer
62 Ubi Road 1, #01-32, Oxley Bizhub 2, 408734 SINGAPORE
Address of Employer Country
6345 7271, 6345 7282 / zia@gie.com.sg 2700.00 SGD
Tel. No./Fax No./E-Mail Address Salary / Currency
GEOTECHNICAL ENGINEER 24 months
Position Contract Duration
January 01, 1970 January 01, 1970
Last Deployment Date Last Arrival Date

LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS

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

RODELIO SALONGA AGUSTIN MALE FATHER June 05, 1966
EMMARIE RUBA AGUSTIN FEMALE MOTHER April 05, 1964
CYRUZ JAKE RUBA AGUSTIN MALE BROTHER March 04, 2001

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LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS

HYACENTH ROSE RUBA AGUSTIN FEMALE SISTER March 17, 2002

RODEL RUBA AGUSTIN MALE BROTHER January 03, 1994
CHARMAINE RUBA AGUSTIN FEMALE SISTER July 25, 1988
CHRISTIAN RUBA AGUSTIN MALE BROTHER December 19, 1991

I hereby certify that the above statements are true and correct.

Control Number: A2235519043

Worker's Signature Over Printed Name

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