PNI INTERNATIONAL CORP. POEA-013-18-011008-R LUNIT 210 Strata 2000 Bidg. Emerald Ave. Ortigas Center Pasig City Tel No. (02) 631-5206/ Fax No. (02) 631-6002 CANDIDATES REQUIREMENTS Employer's Name: S8V\ aX. Candidates Name: _“% Vi¢ a 4 Position: Contact No.: Fmail Address: ‘Skype ID: os 5 % : Date Submitted: Received by: Resume Diploma Certificates Pictures (Passport Size) BI Medical visa Passport Fc Flight Ticket Briefing Documents (DEPLOYMENT FORMS: Dote Submitted: Received by: ‘Agency Agreement Employment Contact, tor Security Deposit Agreement Affidavit for Undertaking. Phil health Form OFW Forms Affidavit of Sworn Statement Candidates Registration Notice Referral for Medical Referral for PDOS Airport Pick-up Formsgg” 2 LM) AFFIDAVIT OF SWORN STATEMENT KNOWN ALL MEN BY THESE PRESENTS tratt, ¥ Victorino tA. Gareta of legal age with residence address at & 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, !am homesick, |am not performing the task assigned to me, | violated labor law cof 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 responsibilty of my actions in cases where | am opting to return to the 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. EXECUTED ON Pasig City, By Name CIC No. Issuedon______ at TinNo. WITNESSED By: REPUBLIC OF THE PHILLIPINES 18.5. 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 Walver and Quitciaim. Releaser exhibited to be the above Community Tax Certificate and acknowledge to me that the same is his true and voluntary act and deed. NOTARY PUBLICPOEA Licence No. POEA-366-1D-030604.8 UNIT 210 STRATA 2000 BLDG. EMERALD AVE. ORTIGAS CENTER PASIG CITY ‘TEL NOS. 631-5206/631-6001/FAX NO. 637-6125 AGENCY HIRED OFW ID FORM. PERSONAL DATA Worker Name: & lkchovine Mediado Coveia First name Middle Name Last Name “oir oate: Sepbember oF Axl cmt sts{) singe (@ <—2 CO) marries (D) widowea Mother's Maiden Name: PHOTO/SIGNATURE Phioto of OFW Signature oFOFW {PLEASE SIGN WITH BLACK PEN WITHIN THE BOX) ‘VERIFIED BY: PRINTED NAME/SIGNATURE DATE VERIFIED FOR USE OF CARD PRODUCTION ONLY OD oe conKNOWN ALL MEN BY THESE PRESENTS: ‘THIS AGREEMENT is made entered into by and between: PNI International Corporation, a corporation duly organized and existing under and by irtue of the laws of the Republic of the Philippines, with office address at Unit 210 2" floor, Strata 2000 Bldg., Emerald Avenue, Ortigas Center, Pasig City represented hereby by its President, Ms. JAN KAY RAVANZO, and hereinafter referred to as the “PI” ade wilicdoryno M- Grarcia filipino, of egal age, 24, and residing t recon aioe icra a -APPLEANT They shall collectively refer to as the Parties. WITNESSETH that: WHEREAS, PNI is a recruitment agency with POEA License Number 013-L8-011008-R Finks to. principal who are in need of qualified WHEREAS, as the APPLICANT desires to avail of the services of PNI for placement in SS eee i oad 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 2 REPRESENTATIONS & WARRANTIES 1. PNI hereby warrants that itis duly licensed recruitment and placement agency that deals with principal 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 is willing to pursue and abide by the rules and regulations of the recruitment process set by PN and made known to the Applicant beforehand, until 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, ‘upon 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 by performing the following: 1. 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. If accepted facilitate securing an employment contract at the assigned principal from ‘and assist the principal in initiating the filling of the applicant's working visa. 3. Process the necessary documents for deployment such as: Overseas Employment Certificate or 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. Right thumb mark: 3ARTICLE 3 RESPONSIBILITIES OF APPLICANT ‘The Applicant shall fulfil its 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 original copies of the following: 4.1 Valid Passport 1.2 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 Certificate 1.6 NBI Clearance 1.7 Trade Test Result 1.8 Medical Results . 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 constantly with the Deployment Administrator and Recruitment Officer who shall guide him/her in fulfiling all the necessary requirements for employment. ‘The candidate may seek advice from PNI Deployment Administrator of Recruitment. Officer if he/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 a in the.ARTICLE 4 PENALTIES PII shail implement corresponding penalties should the applicant fail to fulfill his/her obligations as follows: a z 3 ‘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. In the 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 is obligated to pay PN! the amount corresponding the services which has been rendered prior to the withdrawal of his/her application. PNI shall exercise a lien aver 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. {In cases where the application has been duly processed and referred to a 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 PNI, 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 PII liquidated damages in the amount equivalent to the search fee IVI 1s charging the principal. ARTICLE 5. FEES ‘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 fees. {n this event, candidate is required to pay a placement fee as a agreed with foreign principal. Mobilization / Processing Fees (POEA, Embassy, Admin) however are chargeable to ‘the applicants in the amount of : Security daposit of Dhp ‘which chall be 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. Signature: ae Right thumb mark: ¥‘DO NOT WRITE ON THIS SPACE =a (apo OW, Pest eras ; A ‘PLIPPINE OVERSEAS EMPLOYMENT ADMINISTRATION mums "OVERSEAS WORKERS WELFARE ADMINISTRATION. —— | “pumtivense HEALTH INSURANCE CORPORATION OFW INFORMATION SHEET PERSONAL DATA ‘Changols ff anv) nine B Gavia Vickorimo Mediado sn aZint Sameer Ft Name aaah Me Nae ar inde Witenes OD startet spares Date of shelled deprtae Retr af OFW Yo the bse Name of Agency (it epiler (To be filed in by OF W ~ for PHILHEALTH RECORD) Name of Worker ay Nae Ne OT i Se ang ia Nae] ‘srs te Papin iam tne Bae the ee Btlace : vor bb. WWW se OM OF Ceasame Csi =O Manet (Widowed) Saat Dependents (Mg makikinabang): 0 yes ll nd Meow forse Yeu akan nov or prem an Lnempsyed spouse Sex Redon of FW Deo its es (aun)Hop pFE-6s evoe, 17200 MEMBER'S DATAFORM = (MDF) TWETRUCTIONS | esol hi om no) coy ny raha eth sine. frm. neat name oor FATHER ort MOTHER a8 hey noma your cece ‘eld be pad Boeke back on ang sheet poe. 1. Gnive OCCUPATION forte, net youre, pfesse,e ype woot wah at 2 Type pet ees ft LOCK or CAPTTAL LETTERS. 1 Shine eine patos be povmon en the awa en Succeon une! Pe New Cs Come ‘On the “OCCUPATIONAL STATUE" portion, Hn employed or purpose le. For any tabeaqvant change of oman, date ycire and accomplish amber x Cnant 1 oestpeyoan eae “UNEWPLOFEDNGT YET PLOYED ‘Fitormason Foon (MCI, 90P PPO) ana so ay Pap BIG Branch neat 7: “OCCUPATIONAL STATUS: EMPLOYED TI UNEMPLOVEDINOT YET EMPLOYED 0 check Tus DOKI FRET TM J09 SEoKER. ‘DEMPLOYED PRIVATE SELF-EMPLOYED TT EVPLOYED FOREIGN GOVERNMENT) 0 MENGER OF COOPERATIVE EMPLOYED (GOVERNMENT) | PROFESSIONALIBUSSINESS OWNER] D) BARANGAY OFFICIAUEMPLOYEE TRADE UNON (G EMPLOYED PRIVATE HOUSEHOLD 1] JO8 ORDER PERSONNEL [NONAVORGNG SPOUSE TDOVERSEAS FILPINO nacre CONENGER OF REUGOUS GROUP OTHERS, Pease spacty WORKER: (1D PENSIONERINVESTORLESSOR LAST NAME TRSTHAME— MMCEXTENSON amour nue — NOMDOLE Ate [SeGrarca —_\lichoritan Medindo = FATHER sGorcia Moleini Sr Moreno - "MOTHER gnc ane) Sak ‘Re R = “SPOUBE ‘ . oda : 3 MARITAL STATUS, a Cismpetimened Wow CAmses | SPATERRENTRICATION UME Biter cna aie ‘ee “CITIZENSHIP = CI a ‘ROMINENT OS TINGUISNG FACIAL FEATURES ne moet FREQUENCY OF MEMBERSHIP SAVINGS (WS) PAYMENT (pronto us pat hv pay season) "D Semi-arnuy Qvarery CD Annually "PERMANENT HOME ADDRESS see cone Tneneor he. Foe Badnghae LAN, Bok No, Pasa No Howe Mo Suet Nama Sours AREA COGE YLeProNe nuwece ‘Subawaon, ‘Barangay “MancipaiyiCity ProvncelStaterCounty (Wf abroad), ae Gi Pha TOME ADDRESS Ginaorne eer kang lame tle kNe Pasa. Hae Mo Steet Kame | acaca ————“amenr “tray Paveatinmtoey oma 2 Cale TET aa — "PREFERRED MATING ADDRESS a Present rome Agorass_O Permanent rome Adoress 2 vousiness Access ‘THIS FORM MAY BE REPRODUCED. NOT FOR SALE.1D se Eorg ety ng mt np re omeroty sada Ment nce Pre repre nD Cer Chnaratved Fiore Cen Chu ter costes notice Mateg ate Pcie Spend Gein Peme apy | a. utetme tober "Cia Penearer 1D wer 120 mores sowrouon (Sivas eae vem toe ‘Pena do not wre on thi portion. Fer ingot by Pitan OMe:ith 8.158 Flot, Sage Howto. 110\VA. Rufino Sot Legasoi Vilage, Maka Ciy"1229. Prilopines: COMPULSORY INSURANCE COVERAGE YWeohone +832 772700 Fox +692 12927 FOR MIGRANT WORKER APPLICATION FORM ‘wnpararoun.com: Nature of Employment: D1 Agency Hired 0 Direct Hired © Balk Manggagawa /Re-hired TYPE OF PACKAGE | TERM OF EMPLOYMENT (WBEDO-YYYY) No.of Monts | POEAREGIONAL OFFICE NAME OF RECRUTWENTAGENEY 1 Sea Based Gtand Based ___| Fam x LAST NAME (Apelyido) [FIRST NAME ( MIDDLE NAME (Gitiang Ngan) S Goveia_ _|Wickowine Mediade | GENDER (Kasaran) Sibi | DATEOFBIRTH (PetsangKapanganakan)| PLACE OF BIRTH (Lugar ng Kapanganakan) |GMale (alae) |aSingle Widower | |OFeImale(abae) | GMamed Lega Soparata | ‘STREET ADDRESS (Numero at Kalye) Eee CITY MUNICIPALITY (Lungsod/Murisipyo) x Ro tS | nm San OqUe = | OmnAy | | PROVINCE (Latawigan) [MOBILE / LANDLINE: EMAIL | )AT KUMPANYANG PAGTATRABAHUHAN ‘OCCUPATION (Trabaho) TESTIMATED MONTHLY SALARY (inaasahang] FOREIGN EMPLOYER (Kumpanyang pagtaltabahuhan) | |buwanang sweldo) c PHP USD 1 |STREETADDRESS Nore at Raj) [eFTV7 TOWN (Lungsod Bayan) "PROVINCE / STATE (Lalawigan) — (Barsa) | L __NAME OF BENEFICIARYIIES / PANGUNAHING KAANAK Gi is LastName Middl inal Fst Name Relatonship to Proposed Insured | Telephone Number (Aoshi) {Gitrang Ngslan) _(Pangalen)_ __[Relasyon saAppikanie) | ___(Telepono) | auater __lOnoveszais % Garcia Neling | hereby apply for participation in the Compulsory Insurance Coverage for Migrant Worker plan for which | am or may have become eligible for, subject to the tems and condtons of he Master Policy, Thereby agra that my insurance sal become eective upon approval fhe Company povided tat have met al eigbilty condtons and am in good hes on such date and when the ful pemium cortesponding to my insurance coverage has been paid. | hereby declare and agree that al the foregoing statements, declarations, and names in tis application form together wih those stated in any requested medica examination, questonnaire, or amencment, are ‘and true and correctly recorded and shall form the bass for Paramount Life & General insurance Corporation to determine eligi forthe Insurance Coverage for Migrant Worker and which, with the Master Policy and its attachments, wil constitute the entire contract ‘Ato ay opzyal na nogpopahayeg ng apixaeyon para ta partpasyen ng Compucary Ineurance Covorago for Mant Workor, kung saan ako man ay. 0 maaaring maging kwalpikedo,batay sa mga kataga af kondsyon ng Master Policy. Ako ay sumasang-2yon na ang aking insurance plan ay magiging ‘epektv lamang sa pemamagtan ng pag-eprube ng Kurnpanya batay sa aking pagiugon sa mga kwakpkasyon at btay sa aking pagkokaroon ng maayOs ra kalusugen so araw ng peg-bayed ng kebuvang premium na isinasaad ng saklew ng insurance. Ako ay opisye na ragpapehayed na pag sanayon na ang lahat ng mga nakasaad, deklrasyon, at mga pangalan se apiRasyeng Ro, kasama ng mga nekahayag sa mga ishumteng dokumentong medikal, palatanungan, 0 susog, ay Kump, foton, at wastong infimbag. Angrmga Ro ay magigng baseban ng Paramount Life & General insurance Corporation ‘pang pagpasiyahan ang aking pagiging karapat dapat sa Compulsory Insurance Coverage for Migrant Worker, at s2 pog-buo ng kontrata, kasama ng Mastor Poy ats2 mga attachments nao. Signed at onthe ay! year ae (Nilagaaan sa) (wa) arawng (taong) ‘of Insured ng Aplikante) Tobe fied out he Rectan Agency iH aplcabe for Agency Hired) = Master Poicy No. - Date bored é