THIS FORM IS NOT FOR SALE FM-MPC-OIS-D01

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF LABOR AND EMPLOYMENT
OVERSEAS WORKERS WELFARE ADMINISTRATION

Please fill-out this form legibly

FOR OWWA USE ONLY:

OFW INFORMATION SHEET LAST PAYMENT OF OWWA CONTRIBUTION

OR Number: _________________________________
OR Date: ____________________________________
Validity: ____________________________________
Verified by: _________________________________
RFP No.: ____________________________________
Date: ________________
PERSONAL DATA

TUMANDA JOSEPH PESQUERA

Last Name First Name Name Ext. (e.g. Jr., III) Middle Name
Block 10 Lot 14 Phase 1 Solar Homes Subd. Dasmariñas City, Cavite
Philippine Address:
House No. Lot No. Block No. Phase No. Street Subdivision

Barangay Municipality/City Province Zipcode

09274179271 tumanda_joseph@yahoo.com 09 January 1972
Contact No: E-mail Address: Birthdate :
EC4670905 C0671849 2018061902431
Passport No.: Seaman’s Book No. SRC No.

Civil Status: Highest Educational Attainment: Course:

CONTRACT PARTICULARS

KS PROPERTIES, LIMITED
Name of Company/Employer:
Company Address: PMB 569 1323 SE 17 ST. FT.LAUDERDALE FL 33316
SILVER SHALIS
Vessels Name : Email Address :
Position : CHIEF MATE GEORGE TOWN, CAYMAN ISLANDS
Registry :
Basic Salary : USD 3,900.00 Fax No. :
Contract Duration : 12 MONTHS
Telephone No. :
Name of Agency : EURASIAN MARITIME CORPORATION
Date of Departure :

LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS

Name Relationship Date of Birth Address Contract No. Email Address

NAME OF PARENTS

Name of Father
Family Name First Name Middle Name Employment Status Birth Date (MM/DD/YYYY)
TUMANDA JESUS SUMAMPOL 4/17/1924
Name of Mother
Family Name First Name Middle Name Employment Status Birth Date (MM/DD/YYYY)
TUMANDA FELISA PESQUERA 2/22/1937

JOSEPH P. TUMANDA BELINDA C. WONG

Signature of Seafarer Authorized Agency Representative