BALIK-MANGGAGAWA INFORMATION SHEET

Appointment Date: March 27, 2015 02:00 PM

Processing Site: POEA Field Office (SM Manila)

PERSONAL DATA

MORENO

MARY ANNE

Last Name

First Name

EB7227833

March 16, 1988

Passport

Birth Date

JAMORA
Name Ext. (e.g. Jr.,III)

Middle Name

PASAY CITY

FEMALE

SINGLE

Birth Place

Sex

Civil Status

247 DALANDAN ST. PH.8 GATCHALIAN SUBD. MANUYO DOS Las Pias METRO MANILA
Home Address in the Philippines
SSS

Pag-IBIG RTN/MID

+971504128491

moreno.maryanne@gmail.com

Telephone/Cellphone No.

E-mail Address

Mother's Full Maiden Name:

JAMORA

MARGARET

CAMACHO

Last Name

First Name

Middle Name

First Name

Middle Name

Name of Spouse (If married)

Last Name

CONTRACT PARTICULARS OF OFW

ETIHAD AIRPORT SERVICES-GROUND (FORMERLY ABU DHABI AIRPORT SERVICES

Name of Company/Employer

UNITED ARAB EMIRATES

Address of Employer

Country

-/-

2040.00 AED

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

Salary / Currency

SENIOR WAITER B

24 months

Position

Contract Duration

July 28, 2013

October 03, 2015

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
MARGARET JAMORA MORENO

Sex

Relationship of OFW to Dependent/s

Date of Birth

FEMALE

MOTHER

September 03, 1959

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: M650185184

Worker's Signature Over Printed Name