SWORN STATEMENT OF
DECLARATION, RELEASE AND
QUITCLAIM
This is to certify that I, ARSHIDA KAILO
HAMAD, single, of legal age, holder of
Philippine Passport Number P6743978B and a
resident of Zamboanga del Norte, Philippines,
hereby state and declare the following facts:
1. That I arrived in the Sultanate of Oman
on 14 February 2022 through my
Philippine Recruitment Agency, Prime
Goal International Manpower Inc. and
Oman Foreign Recruitment Agency
(FRA), Arkan Al Motamyeza
Manpower, to work as Household
Service Worker under the sponsorship
of Mr. Yaqoob Mohamed Said Bani
Arab;
2. That I was found to have findings of
Reactive Hepatitis B in my medical
result and therefore UNFIT TO WORK
because of my infectious disease which
caused my sponsor to return me back to
my agency, Arkan Al Motamyeza
Manpower;
3. That due to my medical condition, I am
refusing to work as Household Service
Worker in the Sultanate of Oman and
therefore request my immediate
repatriation;
4. That I would like to go back to
Philippines because, I am refusing to
work with my current sponsor or any
other sponsor within the Sultanate of
Oman and therefore not willing and
unable to complete my two (2) years
employment visa;
5. That my Philippine Agency, Prime Goal
Interntaional Manpower Inc will provide
for my plane ticket and likewise
shouldered all other expenses relevant to
my repatriation;
6. That I have no further claims and/or
complaints against Prime Goal
International Manpower Inc., my
employer and likewise my Oman
Foreign Recruitment Agency, Arkan Al
Motamyeza Manpower;
7. That Arkan Al Motamyeza Manpower
have paid to me all the salaries/wages
due to me by my employer/sponsor;
SINUMPAANG SALAYSAY SA
PAG-UURONG NG DEMANDA AT KASO
Ito ay pagpapatunay, na ako, si ARSHIDA
KAILO HAMAD, walang asawa, nasa hustong
gulang at may Passport Number P6743978B na
nakatira sa Zamboanga del Norte, Philippines,
ay nagpapahayag at deklara ng mga kasunod na
katunayan:
1. Na ako ay dumating sa Bansang Oman
nuong 14 Pebrero 2022 sa pamamagitan ng
aking Recruitment Agency sa Pilipinas,
Prime Goal International Manpower Inc. at
aking agency sa Oman na Arkan Al
Motamyeza Manpower para magtrabaho
bilang kasambahay para sa aking amo na si
Mr. Yaqoob Mohamed Said Bani Arab;
2. Na ako ay napag-alaman na merong
Reactive Hepatitis B sa resulta ng aking
medikal kaya ako kay UNFIT TO WORK
dahil sa aking nakakahawang sakit kaya ako
ay isinoli ng aking sponsor sa aking agency,
Arkan Al Motamyeza Manpower;
3. Dahil sa aking kondisyon sa aking medikal,
ako ay tumatangging magtrabaho bilang
kasambahay sa Oman at ang hiling ko ay
ang agarang pagpapauwi sa akin sa
Pilipinas;
4. Na ako ay gusto ng umuwi sa Pilipinas dahil
ayaw ko na mag trabaho sa aking amo or sa
kahit iba pang amo dito sa Oman kaya ayaw
ko ng tapusin at kumpletuhin ang aking
dalawang taong employment visa;
5. Na ang aking agency sa Pilipinas, Prime
Goal International Manpower Inc. ay
nagbigay at binayaran ng kabuoan na presyo
ng aking plane ticket pauwi at sasagutin din
nila ang mga iba pang gastusin sa
pagpapauwi sa akin;
6. Na ako ay wala ng iba pang hinahabol o
inirereklamo laban sa aking agency Prime
Goal International Manpower Inc., sa aking
amo at sa aking agency sa Oman, Arkan Al
Motamyeza Manpower;
7. Na binayaran na lahat ng Arkan Al
Motamyeza Manpower ang kabuoan ng
aking mga sahod na kailangang bayaran ng
aking amo;
8. That I have not experienced any
maltreatment or any form of physical
and sexual abuse and likewise has been
given proper accommodation and ample
food in both my employer’s residence
and Arkan Al Motamyeza Manpower’s
accommodation;
9. That I apologize to my agencies for not
being able to complete my employment
and express my sincerest gratitude for
their consideration and understanding of
my decision;
10. That I have no further claims and/or
complaints against PRIME GOAL
INTERNATIONAL MANPOWER
INC. and ARKAN AL MOTAMYEZA
MANPOWER before the Philippine
Overseas Employment Administration
and likewise before any other
government agency, including the
National Labor Relations Commission,
Overseas Workers Welfare
Administration, National Bureau of
Investigation, Regional and Municipal
Trial Courts and any other government
agency in the Philippines.
11. That everything that is stated in this
document has been translated in Filipino
and that the same has been understood.
Therefore, affixing my signature and
thumbmark without force and of my
own free will.
Signed this ______ day of March 2022 at Philippine Embassy – POLO, Muscat, Oman.
THUMBMARK
8. Na ako ay hindi nakaranas ng kahit ano
mang pag mamaltrato o ano mang pananakit
at sekswal na pangaabuso at ako ay
nabigyan ng maayos na tuluyan at tamang
pagkain sa bahay ng aking amo at sa
accommodation ng Arkan Al Motamyeza
Manpower;
9. Na ako ay humihingi ng pasensya sa aking
mga agency kasi hindi ko matatapos ang
aking kontrata at ako ay lubos na
nagpapasalamat sa kanilang konsiderasyon
at pag-unawa sa aking desisyon;
10. Na ako ay wala ng kung ano pa mang
hinahabol o nirereklamo laban sa PRIME
GOAL INTERNATIONAL MANPOWER
INC. at ARKAN AL MOTAMYEZA
MANPOWER sa Philippine Overseas
Employment Administration at ganun din sa
mga ibang ahensya ng gobyerno kasama ang
National Labor Relations Commission,
Overseas Workers Welfare Administration
at National Bureau of Investigation at sa
mga korteng Panlalawigan at Munisipyo at
sa kahit saang sangay man ng gobyerno sa
Pilipinas.
11. (Na ang nakasaad sa dokumentong ito
ay ipinaliwanag sa akin ng wikang
Filipino (Tagalog) at ito ay naintindihan
ko. Dahil dito, ang aking paglagda at
paglagay ng thumb marks ay kusang
loob kong ginawa at walang nagpumilit,
nanakot o nagpuwersa sa akin para
gawin ang bagay na ito.)
ARSHIDA KAILO HAMAD