SUBIC BAY METROPOLITAN AUTHORITY DEPARTMENT QUALITY FORM

LBD-MSD-AFG-04-21
LABOR DEPARTMENT REVISION 06
ENDORSEMENT FOR ISSUANCE OF GATE PASS / ID REQUEST FORM EFFECTIVITY DATE: 08/17/2021

THIS ENDORSEMENT IS VALID FOR FIVE (5) DAYS FROM DATE OF ISSUANCE / RELEASE.

Type of Request (Check One)

SBMA BLDG.255,BARRYMAN ROAD NEW X RENEWAL CONTROL NO.:
SUBIC BAY FREEPORT ZONE TEL.NOS. 252.4101/4861/4073 email: msd@sbma.com/scd@sbma.com
CATEGORY (Check One)
INVESTOR / LOCATOR CONTRACTOR / SUB-CONTRACTOR RECEIVED & PROCESSED BY: RELEASED TO:
INVESTOR / LOCATOR'S EMPLOYEES CONTRACTOR / SUB-CONTRACTOR'S EMPLOYEES DATE: (mm/dd/yyyy) DATE:(mm/dd/yyyy)
OTHERS (Specify) TIME: TIME:
SIGNATURE: SIGNATURE:
COMPANY NAME:EXECUTIVE GENESIS SERVICES INC. Type of Registration [ ] CRTE [ ] CR [ ] ACCREDITATION SPONSOR:
FULL NAME LENGTH OF STAY IN DATE OF BIRTH SEX PLACE OF BIRTH
PRESENT ADDRESS PRESENT ADDRESS POSITION
(LAST NAME, FIRST NAME, MIDDLE NAME) (mm/dd/yyyy) M/F TOWN / CITY PROVINCE
AMISTOSO NORIE MAY TUPPIL PRK 6 SABANG MORONG BATAAN SINCE BIRTH PRODUCTION OPERATOR 11/07/2003 F MORONG BATAAN
LAPUZ FATIMA FAMULARCAN PADILLA ST. PRK 1 MAGSAYSAY, CASTILLEJOS, ZAMBALES 20 YRS PRODUCTION OPERATOR 07/26/1997 F HAGONOY BULACAN
CABANISAN JESSA ECLARINAL 2064 UPPER PEK 12 OLD CABALAN, OLONGAPO CITY 15 YRS PRODUCTION OPERATOR 12/24/1998 F STA CRUZ ZAMBALES
TANO JASMINE LIGSAY 34 2ND ST. NEW BANICAIN, OLONGAPO CITY SINCE BIRTH PRODUCTION OPERATOR 06/09/2002 F OLONGAPO CITY ZAMBALES
VIACRUSES HAZEL QUIRINO RIZAL ST. BRGY FARANAL, SAN FELIPE ZAMBALES 15 YRS PRODUCTION OPERATOR 12/26/1998 F QUEZON CITY METRO MANILA
TURNO DESHELEY 1040 MARS LANE ST. STA. RITA, OLONGAPO CITY 17 YRS PRODUCTION OPERATOR 10/04/1999 F CASTILLEJOS ZAMBALES
TOBIA SHERIANN 86 MANANGAN ST. PRK 3A BRGY. MAGSAYSAY, CASTILLEJOS, ZA 15 YRS PRODUCTION OPERATOR 01/03/2003 F SAN MARCELINO ZAMBALES
VERGARA JENIFFER AZANA SITIO MALINGAO CAWAG SUBIC ZAMBALES 20 YRS PRODUCTION OPERATOR 09/06/1994 F PULILAN BULACAN
PIALDA KORINA CHUA 8 NATIONAL RD UPPER KALAKLAN, OLONGAPO CITY 20 YRS PRODUCTION OPERATOR 12/17/1998 F MANILA
CLEMENA PRINCESS 40 FOSTER ST. PRK 4 NEW KABABAE, OLONGAPO CITY SINCE BIRTH PRODUCTION OPERATOR 10/08/2003 F OLONGAPO CITY ZAMBALES
BALAGOT RACHELLE 38 GORDON ST. NEW BANICAIN, OLONGAPO CITY SINCE BIRTH PRODUCTION OPERATOR 09/12/2002 F OLONGAPO CITY ZAMBALES
FALAMINIANO LEYLANIE OLIVA 107 HANSEN ST. EAST TAPINAC, OLONGAPO CITY SINCE BIRTH PRODUCTION OPERATOR 04/10/1992 F OLONGAPO CITY ZAMBALES
COSTALES MARIFEL SAHAGUN BRGY. LAOAG SAN MARCELINO ZAMBAES SINCE BIRTH PRODUCTION OPERATOR 12/04/2003 F SAN MARCELINO ZAMBALES
PALISOC ALYANA JUAN PARAISO, ORANI BATAAN SINCE BIRTH PRODUCTION OPERATOR 09/24/2002 F ORANI BATAAN
OGMAR MARJORY RUIZ HIBOK HIBOK ST. PRK 1 LIBAS NEW CABALAN, OLONGAPO CITY 10 YRS PRODUCTION OPERATOR 05/31/1999 F NAGA CITY CAMARINES SUR
This is to certify that we have willfully provided the information required for the application of our SBMA ID.
Ito ay nagpapatunay na kusang loob naming ipinagkaloob ang mga kinakailangang impormasyon para sa aplikasyon ng aming SBMA ID.
Barbara B. Calderon NEW RENEWAL FROM: TO:
SIGNATURE OVER PRINTED NAME [ ] Endorsement for Issuance of Gate Pass / ID [ ] Endorsement for Issuance of Gate Pass/ ID
OF AUTHORIZED COMPANY Request Form (2 Copies) Request Form (2 Copies)
REPRESENTATIVE [ ] NBI or Police Clearance (1 copy) [ ] Photocopy of Previous ID (1 copy) [ ] CRTE/CR/ Accreditation Atty. MELVIN L. VARIAS
[ ] CRTE/ CR / Accreditation (1 copy) For Lost Gatepass/ID, aside from requirements above: Department Manager, Labor Department
Area in Charge For DIRECT HIRES (Investors/Locators): [ ] Affidavit of Loss [ ] IIO Clearance
POSITION / DESIGNATION [ ] Justification Letter Addressed to: For Foreign Workers/Nationals: Gate Pass / ID Validity
Atty. Melvin L. Varias [ ] Photocopy of AEP Card (if excluded from AEP, photocopy of Certificate of Exclusion/Exemption from DOLE) 1 month
Manager, Labor Department [ ] Photocopy of SCWV / SCIV (if Permanent/Termporary Resident Visa holder, photocopy of 13A Visa 3 months
Attention: Mr. ROMMEL M. AQUINO and Visa Exemption from SBMA Visa Office) 6 months
NOTES: Division Chief, Manpower Services 1 year
1. For SBFZ Locator/Investors with Expired or on process CR or CRTE, please secure an approval from the Office of SDA for Support Services to process SBMA ID (email: osda.ssg@sbma.com) Others
2. For Online application, email to msd@sbma.com [for CR/CRTE holders] or to scd@sbma.com [for Accreditation holders] (specify)
3. For Locator's workers, ID Request is processed at MSD, Rm. 125/138, Bldg. 255 while for Contractors/Subcontractors, is at SCO, Rm. 210, 2nd Flr, Bldg. 255, Barryman Road, SBFZ.
4. For locator workers/applicants aged 15 less than 18 years old as defined under DOLE Department Advisory No. 01-08, in addition to the requirements above:
applicant's Birth Certificate and Notarized parent's consent. The SBMA Labor Department may require additional requirements such as Birth Certificate to verify authenticity of information indicated in this Request Form as deemed necessary.