Citizen Services

Nationwide Coverage

Application Form

Please fill up everything accurately. Leave blank if not applicable.

Personal Info

Last Name	First Name	Middle Name

Date of Birth

Birthplace

Contact Info

Personal Details

Gender		Mother's Maiden Name
Civil Status		Spouse's Name

Highest Education Attained
Passport Number

OWWA Beneficiary (Tatanggap ng Benepisyo)

Beneficiary Name
Beneficiary Address

Salary Allottee (Itinalaga na Padadalhan ng Sahod)

Allottee Name
Allottee Address

Philhealth Dependents

Latest Payment Information

Principal / Employer / Company Details

Contract Details

Position		Job Site
Country Specific Requirements:
Duration	months	Agency
Date Started
Monthly Salary		Currency

Latest Date of Arrival in the Philippines
Scheduled Return Date to the Jobsite

Delivery Information

Address

(Please indicate Landmark and c/o Party or Known Person if necessary)
	City
	Province

Please check the following statements:

	I am returning to the same employer.
	I have the supporting documents to show that I will be returning to the same employer.
	In the event that my OEC application is not processed due to any misrepresentation or lack of supporting documents, I will not hold Pilipinas Teleserv, Inc. liable for the non-issuance of my OEC.

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