SECURING OFW RECORD IS FREE OF CHARGE

REPUBLIC OF THE PHILIPPINES Appoint ment Reference No. (ARN):

Department of Migrant Workers 778251
Blas F. Ople Building, Ortigas Avenue cor. EDSA, Mandaluyong City 1501 Branch Office: DMW Main - Ort igas
Appoint ment Dat e: December 27, 2023
Appoint ment Time: 11:00 AM

REQUEST FOR VERIFICATION / CERTIFICATION OF OFW RECORDS

PERSONAL INFORMATION
NAVARRO GERNALYN QUIMSON
LAST NAME (APELYIDO ) FIRST NAME (PANG ALAN) MIDDLE NAME (G ITNANG APELYIDO )
(MAIDEN NAME FOR FEMALE - KUNG DALAGA PA UMALIS)

QUIMSON GERNALYN DISAL

LAST NAME (APELYIDO ) FIRST NAME (PANG ALAN) MIDDLE NAME (G ITNANG APELYIDO )

09812889508 07/16/1989 PHILIPPINES

CELLPHO NE NUMBER BIRTHDATE (MO NTH/DAY/YEAR) JO BSITE
AG ENCY (AHENSYA NA NAG PA-ALIS)
2012 2012 LB
YEAR O F RECO RDS NEEDED WO RKER CATEG O RY

MODE OF DEPLOYMENT (PAANO NAKAALIS)

AGENCY HIRED DIRECT HIRED BALIK-MANGGAGAWA OT HERS

PURPOSE OF REQUEST (SAAN GAGAMIT IN ANG KINUKUHANG RECORD)

EMPLOYMENT ASSISTANCE REQUIREMENT APPLICAT ION OT HERS
NEW APPLICAT ION BURIAL / INSURANCE DFA VISA OT HERS
RET URNING T O REPAT RIAT ION T ESDA REDUCED T RAVEL T AX (RT T )
SAME EMPLOYER
WHEREABOUT S OWWA PROGRAM LOAN
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 (GIT NANG APELYIDO)
RELAT IONSHIP TO OFW
SPOUSE (ASAWA) SIBLING (KAPAT ID) PARENT (MAGULANG) CHILD (ANAK) RELAT IVE (KAMAG-ANAK)

This is t o cert ify t hat t he OFW record/s being request ed shall be used ONLY for t he purpose st at ed above.

GERNALYN QUIMSON NAVARRO

SIGNAT URE OVER PRINT ED NAME
(Please do not forget to sign before submiting)

<<<<<<<<<< DO NOT FILL OUT THIS PORTION: FOR DMW - GSD PERSONNEL ONLY >>>>>>>>>>
DOCUMENTS PRESENTED ACTION TAKEN (YEAR)
PASSPORT | UMID | SSS | NBI | VOT ERS ID '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15
PHILHEALT H | PAGIBIG | PRC | POST AL ID | LT O MARRIAGE CONT RACT '16 '17 '18 '19 '20 '21 '22 '23 '24 '25 '26
BIRT H CERT IFICAT E SPA / AUT HORIZAT ION
NUMBER OF RECORDS RETRIEVED / PRINTED
LET T ER REQUEST _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 01 02 03 04 05 06 07 08 09 10 11 12 13 14
OT HERS_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15 16 17 18 19 20 21 22 23 24 25 26
OFW RECORD RELEASED
PRINT-OUT (20 Mins .) DIGIT AL IMAGE (25 Mins .) CERT IFIED COPY (8 Hrs .) CERT IFICAT E OF NO RECORD (25 Mins .)
ENDORSED / WRIT T EN REQUEST (15 Days )

RECEIVED EVALUATED & VERIFIED BY REVIEWED & APPROVED BY RELEASING

RECEIVED / ACKNOWLEDGED BY

TIME INITIAL TIME INITIAL TIME

SIGNATURE TIME
TOTAL PCT: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Wit hin PCT More t han PCT

REMARKS: REASON IF TARGET PCT IS NOT ACHIEVED

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2023-12-22 08:57:420