BALIK-MANGGAGAWA INFORMATION SHEET

Appointment Date: August 17, 2017 01:00 PM

Processing Site: POEA Field Office (Trinoma Mall)

PERSONAL DATA
 

PACOT SHIELLA ELISA SANTIAGO

Last Name First Name Name Ext. (e.g. Jr.,III) Middle Name

ec1507124 July 07, 1983 bulacan FEMALE SINGLE

Passport Birth Date Birth Place Sex Civil Status

purok 5 calawitan San Ildefonso BULACAN

Home Address in the Philippines

SSS Pag-IBIG RTN/MID

0965584329 shiela_elisa07@yahoo.com
Telephone/Cellphone No. E-mail Address

Mother's Full Maiden Name:

santiago flordeliza villanueva
Last Name First Name Middle Name

Name of Spouse (If married)

Last Name First Name Middle Name

CONTRACT PARTICULARS OF OFW

UNITECH PRINTED CIRCUIT BOARD CORP

Name of Company/Employer
no. 36-2 dingping rd. dingliao village,suao township yilan city county taiwan TAIWAN
Address of Employer Country

-/- 21000.00 TWD

Tel. No./Fax No./E-Mail Address Salary / Currency

OPERATOR 24 months
Position Contract Duration
April 27, 2016 May 11, 2016
Last Deployment Date Last Arrival Date

LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS

 
Children (20 years old and below) - Registered Birth Certificate; Non-Member Spouse - Registered Marriage Certificate; Parents (60 years old and above) - Senior
Citizens Card and Registered Birth Certificate of Member (OFW)

Complete Name Sex Relationship of OFW to Dependent/s Date of Birth

flordeliza santiago pacot FEMALE MOTHER April 29, 1956
 
I hereby certify that the above statements are true and correct and that the above-named dependents have not been declared by my spouse / brother/sister.

Control Number: P2302943791

Worker's Signature Over Printed Name