FM-POEA-05-WP-02-F

Effective Date: December 17, 2018

SECURING OFW RECORD IS FREE OF CHARGE

Philippine Overseas Employment Administration

Administrative Branch
Central Records Division
Appointment Reference No. (ARN): 560502
Branch Office: POEA Ortigas
Appointment Date: November 07, 2022
Appointment Time: 2:00 PM

ONLINE REQUEST FOR VERIFICATION / CERTIFICATION OF OFW RECORDS

PERSONAL INFORMATION
CALINOG
LAST NAME (APELYIDO)

MICHELLE
FIRST NAME (PANGALAN)

DELA CRUZ
MIDDLE NAME (GITNANG APELYIDO)
(MAIDEN NAME FOR FEMALE - KUNG DALAGA PA UMALIS)

CALINOG
LAST NAME (APELYIDO )

MICHELLE
FIRST NAME (PANGALAN)

DELA CRUZ
MIDDLE NAME (GITNANG APELYIDO)

09158856691
CELLPHONE NUMBER

10/15/1991
BIRTHDATE (MONTH/DAY/YEAR)

JAPAN
JOBSITE

ASIA REACH INTERNATIONAL

AGENCY (AHENSYA NA NAGPA-ALIS)

2018 2020
YEAR OF RECORDS NEEDED

LB
WORKER CATEGORY

MODE OF DEPLOYMENT (PAANO NAKAALIS)

AGENCY HIRED DIRECT HIRED BALIK-MANGGAGAWA OTHERS

PURPOSE OF REQUEST (SAAN GAGAMITIN ANG KINUKUHANG RECORD)

PURPOSE OF REQUEST (SAAN GAGAMITIN ANG KINUKUHANG RECORD)
EMPLOYMENT
NEW APPLICATION

RETURNING TO SAME EMPLOYER

ASSISTANCE
BURIAL / INSURANCE

REPATRIATION
WHEREABOUTS

LEGAL (SUPPORT/COMPLAINT/CASE FILING)

REQUIREMENT
DFA

TESDA

OWWA PROGRAM

APPLICATION
VISA
REDUCED TRAVEL TAX (RTT)

LOAN

OTHERS
OTHERS

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.

MICHELLE DELA CRUZ CALINOG

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
PASSPORT | UMID | SSS | NBI | VOTERS ID PHILHEALTH | PAGIBIG | PRC | POSTAL ID | LTO MARRIAGE CONTRACT

BIRTH CERTIFICATE SPA / AUTHORIZATION LETTER REQUEST___________________________

OTHERS___________________________________

ACTION TAKEN (YEAR)

'03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15 '16 '17 '18 '19 '20 '21 '22 '23 '24 '25
'26
NUMBER OF RECORDS RETRIEVED / PRINTED
01 02 03 04 05 06 07 08 09 10 11 12 13 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

TIME
EVALUATED & VERIFIED BY

INITIAL
TIME
REVIEWED & APPROVED BY

INITIAL
TIME

TOTAL PCT: _______________ Within PCT More than PCT

RELEASING
RECEIVED / ACKNOWLEDGED BY

SIGNATURE
TIME
REMARKS: REASON IF TARGET PCT IS NOT ACHIEVED
Server Error Printer Error Photocopy ID / Requirements Others _________________________________

FOR EDITING / ENCODING: ICT BRANCH LANDBASED CENTER OTHERS: ___________________________________

2022-11-04 10:26:27