Professional Documents
Culture Documents
2021
DATE APPLIED: M: APRIL D: 28 Y: 2022
I. APPLICANT
NAMES LASTNAME FIRST NAME MIDDLE NAME AGE DATE OF BIRTH
APPLICANT: ANCERO JOHN PAUL GESOYOT 22 08-18-1999
Addresses Information (Put “SAME” if address of Permanent same as the Present)
ADDRESS TYPE HOUSE NO./STREET BRGY. /TOWN CITY ZIP COUNTRY
PRESENT PH10B PKG6 BLK85 LOT7 BRGY.176 BAGONG CALOOCAN CITY 1428 PHILIPPINES
PERMANENT PH10B PKG6 BLK85 LOT7 BRGY.176 BAGONG CALOOCAN CITY 1428 PHILIPPINES
Telephones & Contact Information
TELEPHONE MOBILE EMAIL FB
APPLICANT 09383874822 jaypeeancero@gmail.com JOHN PAUL ANCERO
Personal Education (Most Recent on Top)
LEVEL SCHOOL COURSE / DEGREE PLACE FROM TO
COLLEGE DR. CARLOS S. LANTING COLLEGE BS MAR-E QUEZON CITY
SR. HIGH SCHOOL ST. CLARE COLLEGE OF CALOOCAN TVL-ICT CALOOCAN CITY
JR. HIGH SCHOOL KALAYAAN NATIONAL HIGH SCHOOL SECONDARY CALOOCAN CITY
ELEMENTARY KALAYAAN ELEMENTARY SCHOOL PRIMARY CALOOCAN CITY
I have read the above and agree: (Type “YES” or “NO”): __YES___
Type of Cargo
Deck Officer
Engine Type/BHP
Engine Officer
Date/Rev No.: 30 April 2021 / Rev. 0 Authorized by: President Page No.: 5
Residence : PH10B PKG6 BLK85 LOT7 BRGY 176 BAGONG SILANG CALOOCAN CITY__________
Address : __________________________________________________________________________________
YES NO
1. Are you experiencing: a. Sore Throat
□ □
b. Body Pain
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c. Headache
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d. Fever for the past few days
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2. Have you worked together or stayed in the same close environment of a confirmed COVID-
19 case? □ □
3. Have you had any contact with anyone with fever, cough, sore throat in the past 2 weeks?
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4. Have you travelled outside of the Philippines for the last 14 days?
5. Have you travelled in any Area of the NCR aside from your home?
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Specify _________________________________________________
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I hereby authorize 88 ACES MARITIME SERVICES, INC. , to collect and process the data indicated herein for the purpose of effecting
control of the COVID-19 infection , I understand that my personal information is protected by RA 10173 , Data Privacy Act of 2012,
and that I am required by RA 11469, Bayanihan to Heal as One Act, to provide truthful information .