1/10/2020 Printing

BALIK-MANGGAGAWA INFORMATION SHEET

Appointment Date: January 29, 2020 08:00 AM
Processing Site: POEA Main Office (Ortigas)

PERSONAL DATA

BELLEN MANILYN BELEN

Last Name First Name Name Ext. (e.g. Jr.,III) Middle Name
P5974652A January 01, 1987 BACACAY ALBAY FEMALE SINGLE
Passport Birth Date Birth Place Sex Civil Status

P-10 LOWER BONGA Bacacay ALBAY

Home Address in the Philippines
011106243786 121064406965
SSS Pag-IBIG RTN/MID

09556986908 bellenmanilyn01@yahoo.com
Telephone/Cellphone No. E-mail Address

Mother's Full Maiden Name:

BELLEN IMELDA BELEN
Last Name First Name Middle Name

Name of Spouse (If married)

Last Name First Name Middle Name

CONTRACT PARTICULARS OF OFW

LULU HYPERMARKET LLC

Name of Company/Employer
AL QURAIN PB BOX 1050 PC 47411 AL QUSOOR KUWAIT KUWAIT
Address of Employer Country
96525470099 / - 120.00 KWD
Tel. No./Fax No./E-Mail Address Salary / Currency

SALESCLERK/SALES ASSISTANT 24 months

Position Contract Duration
January 25, 2017 January 26, 2017
Last Deployment Date Last Arrival Date

LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS

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

IMELDA B BELLEN FEMALE MOTHER September 09, 1960

I hereby certify that the above statements are true and correct.

https://www.bmonline.ph/receipt/appointment/97c1685de98b734ca01bf20b69f41c27 1/2
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LEGAL BENEFICIARIES / QUALIFIED DEPENDENTS

Control Number: B4505513997

Worker's Signature Over Printed Name

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