3/29/22, 10:37 AM Records | POEA

FM-POEA-05-WP-02-F SECURING OFW RECORD IS FREE OF CHARGE

Effective Date: December 17, 2018
Appointment Reference No. (ARN):
Philippine Overseas Employment
Administration 446004
Administrative Branch Branch Office: POEA Ortigas
Central Records Division Appointment Date: March 29, 2022
Appointment Time: 11:00 AM

ONLINE REQUEST FOR VERIFICATION / CERTIFICATION OF OFW RECORDS

PERSONAL INFORMATION
DELOS REYES ANALIZA MON
LAST NAME (APELYIDO) FIRST NAME (PANGALAN) MIDDLE NAME (GITNANG APELYIDO)

(MAIDEN NAME FOR FEMALE - KUNG DALAGA PA UMALIS)

URBANO ANALIZA TEOFILA

LAST NAME (APELYIDO ) FIRST NAME (PANGALAN) MIDDLE NAME (GITNANG APELYIDO)

09359895414 05/19/1977 SAUDI ARABIA

CELLPHONE NUMBER BIRTHDATE (MONTH/DAY/YEAR) JOBSITE

SPEED CONTINENTAL EMPLOYMENT 2014 2015 BM

AGENCY INC. YEAR OF RECORDS NEEDED WORKER CATEGORY

AGENCY (AHENSYA NA NAGPA-ALIS)

MODE OF DEPLOYMENT (PAANO NAKAALIS)

AGENCY HIRED DIRECT HIRED BALIK-MANGGAGAWA OTHERS
PURPOSE OF REQUEST (SAAN GAGAMITIN ANG KINUKUHANG RECORD)
EMPLOYMENT ASSISTANCE REQUIREMENT APPLICATION OTHERS
NEW BURIAL / INSURANCE DFA VISA OTHERS
APPLICATION
REPATRIATION TESDA REDUCED TRAVEL TAX (RTT)
RETURNING TO
WHEREABOUTS OWWA LOAN
SAME EMPLOYER
LEGAL PROGRAM
(SUPPORT/COMPLAINT/CASE
FILING)

FOR THE AUTHORIZED REPRESENTATIVE (Ang kumukuha ng Record ay HINDI MISMONG OFW)
LAST NAME (APELYIDO) FIRST NAME (PANGALAN) MIDDLE NAME (GITNANG APELYIDO)
RELATIONSHIP TO OFW
SPOUSE (ASAWA) SIBLING (KAPATID) PARENT (MAGULANG) CHILD (ANAK) RELATIVE (KAMAG-ANAK)

This is to certify that the OFW record/s being requested shall be used ONLY for the purpose stated above.

ANALIZA MON DELOS REYES

SIGNATURE OVER PRINTED NAME
(Please do not forget to sign before submiting)
(See second page for Guide, Requirements & Procedures)

<<<<<<<<<< DO NOT FILL OUT THIS PORTION: FOR POEA - CRD PERSONNEL ONLY >>>>>>>>>>

DOCUMENTS PRESENTED ACTION TAKEN (YEAR)

PASSPORT | UMID | SSS | NBI | VOTERS ID '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13
PHILHEALTH | PAGIBIG | PRC | POSTAL ID | LTO '14 '15 '16 '17 '18 '19 '20 '21 '22 '23 '24
MARRIAGE CONTRACT BIRTH CERTIFICATE '25 '26
SPA / AUTHORIZATION NUMBER OF RECORDS RETRIEVED / PRINTED
LETTER REQUEST___________________________ 01 02 03 04 05 06 07 08 09 10 11 12 13
OTHERS___________________________________ 14 15 16 17 18 19 20 21 22 23 24 25 26
OFW RECORD RELEASED
PRINT-OUT (25 Mins.) DIGITAL IMAGE (30 Mins.) CERTIFIED COPY (8 Hrs.) CERTIFICATE OF NO RECORD (25 Mins.)
ENDORSED / WRITTEN REQUEST (15 Days)

RECEIVED EVALUATED & VERIFIED BY REVIEWED & APPROVED BY RELEASING

RECEIVED / ACKNOWLEDGED BY

TIME INITIAL TIME INITIAL TIME

SIGNATURE TIME
TOTAL PCT: _______________ Within PCT More than PCT

REMARKS: REASON IF TARGET PCT IS NOT ACHIEVED

Server Error Printer Error Photocopy ID / Requirements Others _________________________________

FOR EDITING / ENCODING: ICT BRANCH LANDBASED CENTER OTHERS: ___________________________________

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