Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

OVERSEAS WORKERS WELFARE ADMINISTRATION
PHILIPPINE OVERSEAS EMPLOYMENT ADMINISTRATION

OFW ASSISTANCE INFORMATION SYSTEM (OASIS) FORM

(This form is not for sale./ Hindi ipinagbibili ang dokumentong ito.)

Instructions/ Mga tagubilin sa pagsagot:

1. Accomplish the OASIS form either online or manually to guide DOLE/OWWA/POEA in assessing your specific
concerns.
Sagutan ang OASIS form na ito o ang online version upang magabayan ang DOLE/OWWA/POEA sa pagbibigay ng
angkop na serbisyo sa inyo.
2. Online filling out and submission of the OASIS form will facilitate faster action on the part of DOLE/OWWA/POEA
to respond to your concerns and provide assistance. To accomplish the online version, type on browser:
http://oasis.owwa.gov.ph.
Para mas mapabilis ang pagbibigay serbisyo o tulong ng DOLE/OWWA/POEA, hinihikayat ang pagsagot ng form online.
I-type lamang sa browser: http://oasis.owwa.gov.ph.
3. In case it is not possible to accomplish the OASIS form online, write on this printed form legibly. Check the box
(🗹) of appropriate answer. Submit manually accomplished form to authorized DOLE/POLO/OWWA/POEA staff.
Kung hindi kakayanin na masagutan ang online form, pakisulat nang maayos ang mga sagot sa printed form na ito. Lagyan
ng tsek ang box (🗹) na angkop sa iyong kasagutan. Pagkatapos sagutan, i-sumite ang form sa awtorisadong staff ng
DOLE/POLO/OWWA/POEA.
4. All information shared with us will be used in accordance with the Data Privacy Act of 2012.
Lahat ng impormasyon na inyong ibibigay ay gagamitin alinsunod sa Data Privacy Act of 2012.

Name (Pangalan):_______________________/ ___________________________ / ________ / __________________

Surname (Apelyido) Given Name (Unang Pangalan) Suffix (e.g.Jr.) Middle Name
(Gitnang Pangalan)
Passport Number/ Travel Document Number / Certificate of Identity:________________________________________
(Numero ng pasaporte/ Dokumento sa pagbibiyahe / Sertipiko ng pagkakakilanlan)

Birthdate (Kapanganakan): __________/_________ /________ Sex (Kasarian): Female (Babae) Male (Lalaki)
Month(Buwan) Day(Araw) Year(Taon)

Civil Status (Katayuang Sibil): Single(Walang Asawa) Married (May Asawa)

Separated (Hiwalay) Widowed (Balo)

Religion (Relihiyon): Catholic (Katoliko) Islam (Islam) Others, specify (Iba, pakitukoy)_____________________

Permanent Address in the Philippines (Permanenteng tirahan sa Pilipinas):

_________________________________ / __________________________________ / _______________________

House No./Street (Numero ng bahay/Kalye) Subdivision (Pangalan ng Subdibisyon) Barangay (Barangay)

_____________________________________ / ______________________________________/ __________________________

City/Municipality (Lungsod/ Bayan) Province (Probinsya) Region (Rehiyon)

Cellphone Number (Numero ng cellphone): _____________________________________________________________

Email Address:__________________________________ Facebook Account: __________________________________

Nature of Work (Uri ng trabaho): Landbased Seabased

Occupation/ Actual Work Abroad (Aktwal na trabaho sa abroad): ___________________________________________

Country of Work/ Flag of Vessel (If Seafarer): ____________________________________________________________

(Bansa kung saan nagta-trabaho/nagtrabaho / Flag of vessel - kung seafarer)

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Name of Employer/ Company Abroad (Pangalan ng employer o kumpanya sa abroad):_________________________

Address of Company/Employer (Address ng employer o kumpanya): _______________________________________

Name of Foreign Recruitment Agency (Pangalan ng ahensiya sa abroad):____________________________________

Address of Foreign Recruitment Agency (Address ng ahensya sa abroad):___________________________________

Recruitment/ Manning Agency in the Philippines: ________________________________________________________

(Ahensiya ng recruitment / manning sa Pilipinas)

Specific Needs. (Check all that apply) (Natatanging pangangailangan) (Piliin ang lahat ng aplikable):

Person w/ disability (PWD) (May kapansanan)

Pregnant (Buntis)

Elderly (May Edad)

With pre-existing condition (e.g., hypertension, diabetes) (May kondisyong pangkalusugan)

Travelling with infant or child (May kasamang sanggol o bata sa biyahe)

Others, specify (Iba, pakitukoy)____________________________________

In case of emergency, please contact: _________________________________________________________________

(Taong pwedeng kontakin kapag may emergency) Full name of contact person (Buong pangalan ng contact person)

Contact number (Numero ng telepono o cellphone): ______________________________________________________

Relationship to Contact Person (Kaugnayan sa contact person):

Parent (Magulang) Spouse (Asawa) Child (Anak) Sibling (Kapatid)

Others, specify (Iba, pakitukoy)____________________________________

Current Employment Status (Kasalukuyang estado ng empleyo)

Temporarily displaced/ No work - no pay (Pansamantalang walang trabaho) Laid off (Natanggal sa trabaho)

End of contract (Tapos ang kontrata) On Vacation (Naka-bakasyon) Amnesty Recipient (Naka-amnesty)

Nature of Repatriation (Paano uuwi/nakauwi)

Philippine government (Gobyerno ng Pilipinas) Host government (Gobyerno ng bansang pinanggalingan)

Employer/Recruitment Agency (Employer/Ahensiya) Own expense (Sariling gastos)

Flight details (Mga detalye ng flight): __________________________________________________________

Airline and Flight Number (Pangalan ng Airline at Numero ng Flight)

Date of flight (Petsa ng flight): ____________/___________/_________

Month (Buwan) Day (Araw) Year (Taon)

Airport of Origin: _________________________Transit/Connecting Airport, if any: ________________________

(Paliparang pinanggalingan) (Paliparan kung saan nag-transit, kung mayroon)

Airport of Final Destination: ___________________Date and Expected Time of Arrival (ETA): ______________
(Paliparan na lalapagan) (Petsa at inaasahang oras ng pagdating)

[END OF QUESTIONNAIRE]

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