PNI INTERNATIONAL CORP. POEA-013-18-011008-R UNIT 210 Strata 2000 Bldg. Emerald Ave. - Ortigas Center Pasig City Tel No. (02) 631-5206/ Fax No. (02) 631-6001 CANDIDATES REQUIREMENTS. Employer's Name: STATE hp eee Candidates Name: WMI} \_ ws CARA IR. Position: Contact No.: Email Address: Skype 1D: Pl it i li Date Submitted: Received by: Resume Diploma Certificates Pictures (Passport Size) = NBI Medical Visa Passport Ee oEC Flight Ticket Briefing Documents. DEPLOYMENT FORMS: Date Submitted: Received by: ‘Agency Agreement Employment Contact, to! Security Deposit Agreement Affidavit for Undertaking Phil health Form OFW Forms Affidavit of Sworn Statement Candidates Registration Notice Referral for Medical Referral for POOS Airport Pick-up FormsAFFIDAVIT OF SWORN STATEMENT KNOWN ALL MEN BY THESE PRESENTS Mein Pr. UARAK IR. of legal age with residence address at 7 do by these presents swear that | will take full responsibility of my repatriation and whatever cost may occur in case | resign without due cause from my employer, lam homesick, | am not performing the task assigned to me, | violated labor law of my employer's country, | became pregnant or | got someone pregnant, | committed unjust actions, | participated in illegal union, | committed stealing or crime and the like in consideration whereof, | promise to take full responsibility of my actions in cases where | am opting to return to tthe Philippines due to reasons stated above or related to the above. Failure to do shall warrant PNI International and employee to file a case against me. That, EXECUTED ON Pasig City, ey ‘Name CTC No. Issued on at Tin No. WITNESSED BY: REPUBLIC OF THE PHILLIPINES — ) dss. Before me a Notary Public for and In, personally appeared the fore signed. Releaser knows to me and to me knows to be the same person who executed the foregoing, Release Waiver and Quitclaim. Releaser exhibited to be the above Community tax Certificate and acknowledge to me that the same is his true and voluntary act and deed Doc No. NOTARY PUBLIC Page No. Book No, Series of,a | POEA License No. POEA-366-1D-030604.8 bh ) UNIT 210 STRATA 2000 BLDG. EMERALD AVE. ORTIGAS CENTER PASIG CITY 2k ‘TELNOS. 631-5206/631-6001/FAX NO. 637-6125 AGENCY HIRED OFW ID FORM. PERSONAL DATA Worker Name: = myoint .Je- MEDIADO Ke A First rame Middle Name cast Name Birth Date:_ WAY 04 (494 ivi status) single CD separate Married CD widowes ‘Mother's Maiden Name: PHOTO/SIGNATURE Photo of OFW Signature of OPW (PLEASE SIGN WITH BLACK PEN WITHIN THE BOX) VERIFIED BY: PRINTED NAME/SIGNATURE DATE VERIFIED FOR USE OF CARD PRODUCTION ONLY RMI cotKINOWN ALL MEN BY THESE PRESENTS: THIS AGREEMENT is made entered into by and between: NI international Corporation, a corporation duly organized and existing under and by virtue of the laws of the Republic of the Philippines, with office address at Unit 210 2" floor, Strata 2000 Bidg., Emerald Avenue, Ortigas Center, Pasig City represented hereby by its President, Ms. JAN KAY RAVANZO, and hereinafter referred to as the “PNI” and- SS ABIN | ms Lecr& Se Filiping, of legal age, 4B _ and residing at wske_PoQu E BASAS ( EATAN GAS hereinafter referred to as CRPPLCANT™ ‘They shall collectively refer to as the Parties. WITNESSETH that: WHEREAS, PNI is a recruitment agency with POEA License Number 013-L8-011008-R links to principal who are in need of qualified WHEREAS, as the APPLICANT desires to avail of the services of PNI for placement in WHEREAS, the parties herein have agreed to come to into this agreement subject to certain terms and conditions; NOW, THEREFORE, for and in consideration of the above premises and mutual covenants herein unto agreed upon, the parties hereto agree as follows: ARTICLE 1 REPRESENTATIONS & WARRANTIES 2. PNI hereby warrants that itis duly licensed recruitment and placement agency th deais with principals in who desire to employ from the Philippines who shall meet the professional standards mandated by the Government, as well is the {qualification standards defined by the principals; 2. The Applicant hereby warrants that he/she is a skilled worker of good standing in the Philippines, and that she i willing to pursue and abide by the rules and regulations of the recruitment process set by PNI and made known to the Applicant beforehand, Luntit he/she is finally deployed to a principal 3. The Applicant further warrants that he/she has not applied with any other agency for ‘the employment in nor does him/her have any‘contract of employment with any Middle East principal or that he/she does not have any pending processing agreement for employment in the with any other agency. 4, PNI shall expedite the deployment of the applicant within the most ideal time frame, tupon his/her submission of all credentialing documents and successful completion of all required exams/interviews. However, both parties understand the time frame for deployment is contingent on the processing schedule of the host country. ARTICLE 2 RESPONSIBILITIES OF PNI NI shall fulfill its obligation to place the applicant with principal bby performing the following: 11. Orient the applicant on the recruitment and placement procedures of the Agency ‘and its principals, visa processing, medical examinations that need to be successfully order to secure employment in and provide written materials for this purpose. 2. Ifaccepted facilitate securing an employment contract at the assigned principal from ‘and assist the principal in initiating the filing of the applicant's ‘working visa. 3. Process the necessary documents for deployment such as: Overseas Employment Certificate of Exit Clearance from Philippine Overseas Employment Administration (POEA); Visa stamping; referring the applicants to Pre-departure; Orientation ‘Seminar (PDOS); and confirm/verify the airline booking of the applicant from the Pre-paid Ticket Advise given by the principal.Signatur Right th ARTICLE 3 RESPONSIBILITIES OF APPLICANT The Applicant shall fulfil ts obligation to pursue and abide by the rules and regulations of the recruitment process until he/she is finally deployed to a Middle East principal, my accomplishing the following: ‘Submit to PNI the origi 1,1 Valid Passport 11.2 Resume with work history and detailed job description 1.3 Passport sized pictures with and without name and white background 1.4 College diploma and transcript of records 1.5 Copy of Employment Cert 1.6 NBI Clearance 1.7 Trade Test Result 1.8 Medical Results al copies of the following: Attend the orientation seminars conducted by PNi on the recruitment and placement procedures of the Agency and its principals, and the documents needed to be accomplished in order to secure employment ‘among others. Cooperate fully and communicate constantiy with the Deployment Administrator and Recruitment Officer who shall guide hirn/her in fulfilling al the necessary requirements for employment. ‘The candidate may seek advice from PNi Deployment Administrator of Recruitment Officer ifhe/she was not able to pay the direct deployment cost in due time Take the responsibilities for informing the deployment administrator for any changes in the applicants contact information, place of residence, civil status, local ‘employment status or any other information relevant to his/her ongoing job. Perform all other duties and actions necessary in order to secure employment as 2 inthe ark:ARTICLE 4 PENALTIES PNT shall implement corresponding penalties should the applicant fal to fulfil his/her obligations as follows: 1. Should the candidate withdraw acceptance of the employment given by the principal, the direct deployment cost of the POEA and Embassy will no longer be refundable. 2. Inthe event that the applicant withdraws his/her application after services has been rendered by PNI, work visas & PTA’s are already purchased by the principals, the applicant i obligated to pay PNI the amount corresponding the services which has ‘been rendered prior to the withdrawal of his/her application. PNI shall exercise a lien over the original documents in its possession and will turn over to the applicant said documents only after the applicant's obligations have been paid in full. 3. In-cases where the application has been duly processed and referred toa prospective or present principal by PNI, the applicant shall furthermore not be allowed to deal directly with the principal, or any other principal in the same country, without prior written consent of PN, which shall be given upon payment of the appropriate fees to PNI. In case of violation of this provision, the applicant shall be liable to pay PNI liquidated damages in the amount equivalent to the search fee PINs charging the principal. ARTICLES FEES 41. The costs and service fees of PNI for undertaking this recruitment and placement activity are generally paid by the foreign principal; therefore these services are rendered at no fees to the applicant except if an arrangement with the principal is salary deduction on the candidates’ part or applicants are required to pay placement foes. {n this event, candidate is required to pay a placement fee as a agreed with foreign principal. 2. Mobilization / Processing Fees (POEA, Embassy, Admin) however are chargeable to the applicants in the amount of 2. Security deposit of Php. which chall bo RETURNED after completion of ‘employment contract with. (Security deposit agreement annexed)ARTICLE 6 GOVERNING LAW ‘The parties agree to work together to settle amicably any dispute arising from this Agreement. However, failure to resolve the same shall be settled in accordance with the arbitration rules of the Philippines Dispute Resolution Center, Inc. and interpreted in accordance with the laws of the Republic of the Philippines. IN WITHNESS WHERE OF, the parties hereto have affixed their signatures on This day of 20__in Manila, Philippines. Right thumb mark: ¥Tarr rnaT ‘bo SOF WATE ON Fis sPACr ULIPPINE OVERSEAS EMPLOYMENT ADMINISTRATION ‘OVERSEAS WORKERS WELFARE ADMINISTRATION. ‘PHILIPPINE HEALTH INSURANCE CORPORATION OFW INFORMATION SHEET PERSONAL DATA, ‘Changes lif any) Name S_ GARCIA DAG IPI, IR- WEDIADO Tamiya Tia Peay Same, Ai Name Fri Compans Fave Air ‘Nese omy of Desi Fane: Poche OC, Fa Eel nbons awd of ane of acon worker ite Pie Dt of chau paar” af OFW to he bse Name of Aseny iapptese Tiga of Wolo So ee "Thana Represeniive ifageney hired (To be filled in by OFW — for PHIL HEALTH RECORD) Fan Sane ROT ‘ter ge res sn SEE REE RY wt b> WW sec OM ELF Gvtsaus: Sige OD Mant C] Witwed Sega Dependents (Mg makiinabang) 20 yous ld ane fr co, year and above for parent an Unc pe Name. 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Maka City 1229, Phiipines ‘COMPULSORY INSURANCE COVERAGE Telephone +632 7729200 Fax +632 7729291 FOR MIGRANT WORKER APPLICATION FORM INSURANCE 0 CORPORATION wrnporamountcom on Nature of Employment Agency Hired Oi Direct Hired CO Balk Managagewa / Rechired TYBE OF PACKAGE [TERWOFENPLOYWENT (IMLOD-YYYY) [No ctl: [POEAREGIONAL OFFICE NAME OF RECRUTIENT AGENCY |] 1 Sea Based | | Band Bases om a | i i ‘PERSONAL INFORMATION /IMPORMASYON NAUUKOL SAAPLIKANTE E | | ‘GENDER (Kasaran) [CIVIL STATUS (Kalagayang Sti | DATEOFBIRTH (PetsangKanancanakan)| PLACE OF BIRTH (Lugar na Kananganakan) @iae (Laak) Single Widower |G Feel (Baiee) —urtarten CLegalySepariea | pay 04 7af | @vE70N ie | STREET ADDRESS (Numero Kaho) TITY TMUNICIPALITY (LangsedMunsipyo) | nn Sh ROQUE BAVAN |PROVINGE (Lalawagen) | MOBILE LANDLINE "EMAL [Baru bse | odor get F272 | garcons HOrchovem ke EMPLOYMENT INFORMATION | IMPORMASYON UKOL SA TRABAHO AT KUMPANYANG PAGTATRABAHUHAN | OCCUPATION (Trabaho) TESTIMATED MONTHLY SALARY (inaasahang | FOREIGN EMPLOYER (Kumpanyang pagtatrabahvhan) | | STREET ADDRESS (Nu See TongsadiBayen) 1 PROVINCE STATE (Lalawigan) [COUNTRY (Bans) NAME OF BENEFICIARYIIES / PANGUNAHING KAANAK NAMAKAKATANGGAP NG BENEPISYO Relatenshp to Proposed inured | Telephone Number Last Name. ‘Middle intial First Name | | (Apel) (Ginang Ngslan) | __(Pangalan)___|__iRelasyon sa Appéhante) | (Felepono) 9 Gheah pee WAR CEL / WIE t oll = yy | | IPR CASS D’ G | (0942 St0SF25~ [ie Re aie BG | poe ele ATA MR t 2D a ee | nreby appl or patcpaton in the Compulsory Insurance Coverage for Migrant Worker pan for which | am or may have become elge for, subect tothe terms and conditions of the Master Poy. | hereby agree that my insurance shal become efectiva upon approval af the Company provided that | have mot al elgiityconditons and am in good health on such date and when the full premium corresponding to my insurance coverage has been paid. | hereby declare and agree tat all the foregoing statements, declarations, and nares in tis appécaton form together with those sisted in any requested medical ‘examination, questonnar, oF amendment, ae complet and true and correctly recorded and shal form the bass for Paramount Life & General insurance Corporation, to determine eligi forthe Compusory Insurance Coverage for Migrant Worker and which, withthe Master Policy and is attachment, wil coneftte the enti contrac. Ako ay opieyel no nageapahayag ng aplikasyen para 2a parteipasyon ng Compulsory inurance Coverage for Migrant Workor lung easn ako man oy ‘o maaaring maging hwalipkado, balay sa mga kataga at kondlsyon ng Master Policy Ako ay sumasang-ayon na ang aking insurance plan ay magiging ‘epekibo lamang s9 pamamagtan ng pag-apruba ng Kumparya batay 53 aking pagtugon sa mga kwalpkasyon at balay sa aking pagkakaroon rg maayos na kalusugan sa araw ng pag-bayed ng kabuuang premium ra isnasaed ng SaNaw ng insurarce. Ako ay opsyal na nagpapahayeg ng pag sang-ayon ra ang lahat ng mga nakasaad, dekarasyon, at mga pangalan sa epikasyong to, kasama ng mga nakahayag s@ mga isinumteng dokumentong medal, alatanungan,o susog, ay kumpeto, foto, at wastong iniimbag.Angmiga to ay magiging basehan ng Paramount Life & General Insurance Corporation pang pagpasiyahan ang aking pagiging karapat dapat 6a Compulsory insurance Coverage for Migrant Werker, a so pog-buo ng kontrat, kasama ng Mastor Policy at sa mga attachments nto = Signed at __ ‘onthe day! year > ‘Mts a tia) 09 aon Soot (Lagda’ng Apikante [te fiedodby te Renta ippatintigwadind SSS 1 nese = = a a pa |