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RKS Form 5 of 2020 - As of 11 June 2020
RKS Form 5 of 2020 - As of 11 June 2020
Instructions:
1. Accomplish this form when filing a notice of: a) Flexible Work Arrangement/Alternative Work Scheme; b) Temporary Closure;
c) Retrenchment or Reduction of Workforce; or d) Permanent Closure.
2. The report is considered as duly filed when the complete list of workers affected is made part of the submission. Fields with asterisks
(*) should be accomplished by the company representative.
3. This form should be submitted to the DOLE Provincial/Field Office as soon as possible in the case of adoption of flexible work
arrangement or temporary closure.
4. For establishments that will retrench or permanently close, the form should be submitted 30 days prior to the effectivity of
termination.
5. Page 1 should contain general information about the establishment and the number of workers affected.
6. Page 3 should enumerate the names of workers affected, their addresses and contact numbers, and other information stated therein.
7. Total number of workers listed should equal the total number of workers affected as reported in this page.
ESTABLISHMENT REPORT
□ FLEXIBLE WORK ARRANGEMENT (FWA) / ALTERNATIVE WORK SCHEME (AWS)
□ TEMPORARY CLOSURE
□ RETRENCHMENT/REDUCTION OF WORKFORCE
□ PERMANENT CLOSURE
Date of Filing (mm-dd-yyyy): 0 4 - 2 5 - 2 0 2 4
A. ESTABLISHMENT INFORMATION
*Name of Establishment:
NUTRIMEAL AGRI-BUSINESS, INC.
*Floor/Bldg/No/Street/Subdivision :
*Barangay/City/Municipality : SAN IGNACIO, ROSARIO, BATANGAS
Geo Code :
Kind of Business/Economic : MANUFACTURING
Activity/Principal Product:
PSIC Code :
*Company TIN : 006-031-701-000
*Company SSS Number : 04-1001619-2
*Number of Workers Male : 16 Managerial Employees : 1
Female : 7 Supervisory : 3
Total : Rank-and-File : 19
23 Total : 23
Codes for Primary Reason Temporary Closure (B.2)/Retrenchment (B.3) / Permanent Closure (B.4):
D. CERTIFICATION
This is to certify as to the accuracy of the data provided in this report.
CONSENT NOTICE: By accomplishing this form, you agree that the information submitted shall be used solely for purposes of monitoring and planning. We may likewise disclose your personal information to the
extent that we are required to do so by the Data Privacy Act of 2012. As a general rule, we may only keep your information until such time that we have attained the purpose by which we collect them. Under the
foregoing circumstances and to the extent permissible by applicable law, you agree not to take any action against the DOLE for the disclosure and retention of your information.
Employment
Status*
Name of Worker* Home Address* Email Address* Designation* (regular, Monthly Salary (in Peso)*
contractual, Adopted
Birthday* Sex* Contact etc.)
No. Work
(dd/mm/yyyy) (F/M) No*
Arrangement*
10,001 22,001 28,001
Last First Middle House City/ 4,000- 16,001-
Street Brgy. Province - - and
Name Name Name Number Municipality 10,000 22,000
16,000 28,000 above
Alcayaga Ruben Padillo 10/11/1972 M Malaya Rosario Batangas N/A rubenalcayaga2@gmail.com Production Regular 11,500
1
Operator
Deanon Ryan Buhayan 03/05/1998 M Malaya Rosario Batangas N/A ryandeanon57@gmail.com Production Regular 11.500
2
Operator
Mayola Joseph Gapo 12/08/1981 M Block17, Quilib Rosario Batangas N/A mayolajoseph1208@gmail.com Production Regular 17,000
3
Lot 18 Leadman
4
Montales Darwin Orilla 05/02/1993 M Malaya Rosario Batangas N/A
darwinmontales905@gmail.com Production Regular 11,500
Operator
Morante Roderick Rodelas 11/30/1989 M San Rosario Batangas N/A moranteroderick@gmail.com Production Regular 13,000
5 Ignacio Operator / Premix
Operator
Moro Gilbert Nollas 01/28/1984 M Poblacion Taysan Batangas N/A morogilbertn@gmail.com Premix Operator / Regular 15,000
6 West Asst. QC
Inspector
Palso Arvin 02/10/1995 M Masaya Rosario Batangas N/A Production Regular 11,500
7
Operator
Pascua Raymond Lorenzo 12/06/1992 M Timbugan Rosario Batangas N/A raymondpascua1206@gmail.com Production Regular 13,000
8 Operator / Premix
Operator
9 Rutaquio Roberth Vertude 08/07/1976 M San Rosario Batangas N/A rutaquioroberth@gmail.com Inventory Control Regular 15,000
z Ignacio
NOT FOR SALE
Clerk
10
11
12
13
14
15
16
*a