ANNEX C

Overseas Workers Welfare Administration

WELFARE ASSISTANCE PROGRAM (WAP)
FOR OFWs/FAMILIES AFFECTED BY NATURAL CALAMITIES/DISASTERS
Regional Welfare Office- CAR

CLAIM FORM
OFWS DATA

Name of OWWA Member: _________________________________________________________________________

(Last Name) (First Name) (Middle Name) (Suffix)

Birthdate: _________________ Sex: ______ Civil Status: ________________ Status of Membership: Active
Address: ________________________________________________________________________________________

CLAIMANTS DATA

Name of Claimant: _________________________________________________________________________

(Last Name) (First Name) (Middle Name) (Suffix)

Relationship to the OFW: _____________________ Claimant’s Contact Number: ________________________

Birthdate: _________________ Sex: ______ Civil Status: ________________

Claimant’s Address: _______________________________________________________________________________

Documents Submitted: Proof of relationship to the OFW. If claimant is not the OFW member
(Pls. Specify: ________________________________________________________________)
Copy of any proof of identity (Pls. Specify: _____________________________________ )
CERTIFICATION AND ACKNOWLEDGEMENT

I hereby certify that the information given herein are true and correct to the best of my personal
knowledge.

Received the amount of ______________________________________(Php_____________) under the

Welfare Assistance Program for the affected OFW-members/families by natural calamities/disasters.

I further declare that:

I belong to the family/individuals residing in calamity areas affected by the JULY 27, 2022 EARTHQUAKE
There is no other OFW-family member who availed of this program; and
I may be liable for any false statement or representation made in this document.

_______________________________________ _______________________
Signature over Printed Name of Claimant Date of Application

THIS PORTION IS FOR OWWA USE ONLY

WAP APPROVAL Php __________________________

Amount Granted

Received by: Approved by:

______________________________________ ______________________________________
Processor Officer-In-Charge

Date: _______________________ Date: _______________________