3/4/22, 11:59 PM Records | POEA

FM-POEA-05-WP-02-F SECURING OFW RECORD IS FREE OF CHARGE

Effective Date: December 17, 2018
Appointment Reference No. (ARN):
Philippine Overseas Employment
Administration 432099
Administrative Branch Branch Office: POEA Ortigas
Central Records Division Appointment Date: March 07, 2022
Appointment Time: 1:00 PM

ONLINE REQUEST FOR VERIFICATION / CERTIFICATION OF OFW RECORDS

PERSONAL INFORMATION
CARMAN GEMMA BOTOR
LAST NAME (APELYIDO) FIRST NAME (PANGALAN) MIDDLE NAME (GITNANG APELYIDO)

(MAIDEN NAME FOR FEMALE - KUNG DALAGA PA UMALIS)

BOTOR GEMMA BARANDON

LAST NAME (APELYIDO ) FIRST NAME (PANGALAN) MIDDLE NAME (GITNANG APELYIDO)

09619835364 07/07/1976 HONG KONG

CELLPHONE NUMBER BIRTHDATE (MONTH/DAY/YEAR) JOBSITE

J~MAC INTERNATIONAL MANPOWER 2009 2016 LB

AGENCY YEAR OF RECORDS NEEDED WORKER CATEGORY

AGENCY (AHENSYA NA NAGPA-ALIS)

MODE OF DEPLOYMENT (PAANO NAKAALIS)

AGENCY HIRED
DIRECT HIRED
BALIK-MANGGAGAWA
OTHERS
PURPOSE OF REQUEST (SAAN GAGAMITIN ANG KINUKUHANG RECORD)
EMPLOYMENT ASSISTANCE REQUIREMENT APPLICATION OTHERS
NEW BURIAL / INSURANCE DFA VISA OTHERS
APPLICATION
REPATRIATION TESDA REDUCED TRAVEL TAX (RTT)
RETURNING TO
WHEREABOUTS OWWA LOAN
SAME EMPLOYER
PROGRAM
LEGAL
(SUPPORT/COMPLAINT/CASE
FILING)

FOR THE AUTHORIZED REPRESENTATIVE (Ang kumukuha ng Record ay HINDI MISMONG OFW)
LAST NAME (APELYIDO) FIRST NAME (PANGALAN) MIDDLE NAME (GITNANG APELYIDO)
RELATIONSHIP TO OFW
SPOUSE (ASAWA)
SIBLING (KAPATID)
PARENT (MAGULANG)
CHILD (ANAK)
RELATIVE (KAMAG-ANAK) 

This is to certify that the OFW record/s being requested shall be used ONLY for the purpose stated above.

GEMMA BOTOR CARMAN

SIGNATURE OVER PRINTED NAME
(Please do not forget to sign before submiting)
(See second page for Guide, Requirements & Procedures)

<<<<<<<<<< DO NOT FILL OUT THIS PORTION: FOR POEA - CRD PERSONNEL ONLY >>>>>>>>>>

DOCUMENTS PRESENTED ACTION TAKEN (YEAR)

PASSPORT | UMID | SSS | NBI | VOTERS ID '03
'04
'05
'06
'07
'08
'09
'10
'11
'12
'13
PHILHEALTH | PAGIBIG | PRC | POSTAL ID | LTO '14
'15
'16
'17
'18
'19
'20
'21
'22
'23
'24
MARRIAGE CONTRACT
BIRTH CERTIFICATE '25
'26
SPA / AUTHORIZATION NUMBER OF RECORDS RETRIEVED / PRINTED
LETTER REQUEST___________________________ 01
02
03
04
05
06
07
08
09
10
11
12
13
OTHERS___________________________________ 14
15
16
17
18
19
20
21
22
23
24
25
26
OFW RECORD RELEASED
PRINT-OUT (25 Mins.)
DIGITAL IMAGE (30 Mins.)
CERTIFIED COPY (8 Hrs.)
CERTIFICATE OF NO RECORD (25 Mins.)
ENDORSED / WRITTEN REQUEST (15 Days)

RECEIVED EVALUATED & VERIFIED BY REVIEWED & APPROVED BY RELEASING

RECEIVED / ACKNOWLEDGED BY

TIME INITIAL TIME INITIAL TIME

SIGNATURE TIME
TOTAL PCT: _______________
Within PCT
More than PCT

REMARKS: REASON IF TARGET PCT IS NOT ACHIEVED

Server Error
Printer Error
Photocopy ID / Requirements
Others _________________________________

FOR EDITING / ENCODING: ICT BRANCH

LANDBASED CENTER
OTHERS: ___________________________________
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