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Republic of the Philippines

Department of Migrant Workers


OVERSEAS WORKERS WELFARE ADMINISTRATION
Regional Welfare Office 9
Email: region9@owwa.gov.ph
Contact Nos.: (PLDT) (062) 991-2785 / (GLOBE) (062) 313-4532 / (SMART/TNT) (+63) 918 702
5411
BALIK-PINAS! BALIK-HANAPBUHAY! PROGRAM FOR DISPLACED
OFWs

EVALUATION FORM

Name:
Address:
Contact No.:
Gender:
Status of Membership:

[ ] Active [ ] Non-Active

Amount:

DOCUMENTS SUBMITTED: COMMENTS/REMARKS:

( ) OWWA Membership ( Updated )


( ) BAP Record
( ) Passport / Travel Document ( Departure & Arrival )
( ) Proof of Distress
( ) Barangay Certificate
( ) Site Inspection Report
( ) FINLIT/EDT Certificate
( ) Business Canvas

Evaluated by: Recommending Approval:

JENALYN R. ESPIRITUSANTO MARICRIS S. ABASTAS


FWO OIC – PSD
Approved by:

ROSALITO J. SULTAN
OFFICER-IN-CHARGE

SALAYSAY
_________________________________
Signature over Printed Name of OFW

Date: ____________________

_________________________________________________
Signature Over Printed Name of Family Welfare Officer

SITE INSPECTION REPORT


DESCRIPTION:

_________________________________
Signature over Printed Name of OFW

Date: _____________________________
Place: ____________________________

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