FOR EX-GCC EMPLOYEES:

Name: _________________________________ Date: ____________________________

Employer: ________________________________ Position: ____________________________

QUESTIONNAIRE

Please answer the following questions truthfully to assess and possibly avert any immigration problem on re-mobilization to the
Kingdom of Saudi Arabia or any GCC countries with a new employer:

1. Latest return to the Philippines from any GCC country (Saudi Arabia, UAE, Qatar, Bahrain, Kuwait, Oman)

Check the visa type: (a) work visa ___________ (b) visit visa ____________
Specify country and date:
______________________________________________________________________________________

2. If on work visa, were you issued a “Letter of No Objection”

or “No Objection Certificate” by your last employer Yes ______ No ______

3. Do you have any valid or existing re-entry visa that

has not been cancelled? Yes ______ No ______

If yes, which country? ___________________

4. In the past years, did you have any re-entry visa

that was not cancelled? Yes ______ No ______

If yes, which country? ___________________

Did you just let such re-entry visa expire? Yes ______ No ______

5. Where you finger-printed upon entry at any GCC country? Yes ______ No ______

If yes, which country? ___________________

6. Do you have any bank / credit card liability before you left the GCC? Yes ______ No ______

7. Did you have un-authorized resignation (e.g. while on vacation; Yes ______ No ______
abandonment at the job site)?

8. Have you been involved in a situation where Police Authorities

had to intervene or did you encounter any problem with your
previous employer? Yes ______ No ______

If yes, please explain below (state the circumstances, duration if detained, and if clearance was obtained prior to
return to the Philippines).
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

Please provide any documentation to support your statements above.

UNDERTAKING

I, __________________________________________, certify to the truthfulness of the above information and hereby

release IPAMS and its client from any responsibility whatsoever should the Embassy refuse to grant me entry visa,
and/or the Immigration Officer refuse my re-entry to any GCC country.

That, should the GCC Immigration Officer refuse my re-entry and eventually deport me to the Philippines as a result of
my concealing any relevant information concerning my previous employment and residency in any GCC country, I
hereby agree to reimburse IPAMS any and all amounts that have been incurred on my behalf including airfare,
processing fees and administrative expenses; and that, I will relieve IPAMS free and harmless from any responsibility
whatsoever.

That, I am executing this Undertaking to attest to the truthfulness of the above information.

_____________________________
(Signature Over Printed Name)

Date: _________________________

Witness: ______________________

Revised Dec. 14, 2017

Yolly | [SCHOOL]