Balik Manggagawa Form – Fill Out and Use This PDF

THIS FORM IS NOT FOR SALE										DATE: ______________________
USE BLACK OR BLUE PEN ONLY
										DO NOT W RITE ON THIS SPACE
	TIM E	TIM E								(For POEA, OW W A, Philhealth, Pag-Ibig
										Only)
	RECEIVED	RELEASED								CG NO .: ___________________
	BM EVALUATOR:									RFP NO.: ___________________
				POEA		OW W A		PHILHEALTH
									PAG-IBIG
										ASSESSM ENT NO .: ____________
_______________________
										ASSESSED AM OUNT :
__________		___________								POEA: __________________
	BM ASSESSOR/ CASHIER:			BALIK-MANGGAGAWA						OW W A: _________________
_______________________				INFORMATION SHEET						PHILHEALTH: _____________
__________		___________
										PAG-IBIG: _______________
						PERSONAL DATA
	Last Name		First Name						Name Ext. (e.g. Jr.,III)		Middle Name

Lot No. Block No. Phase No.	House No.	Street Name	Subdivision
Municipality/City	Province		ZIP Code

Last NameFirst NameMiddle Name

					CONTRACT PARTICULARS OF OFW
Name of Company/Employer:
Address of Employer:
Tel. No./Fax No./E-Mail Address:							Salary / Currency:
Position:							Contract Duration:
Date of last deployment from the Philippines:							Date of recent return/arrival to the Philippines:

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		Date of Birth
				to Dependent/s

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.

Worker's Signature Over Printed Name

FOR BM GROUP/AGENCY

Name of Agency:

Approval of Authorized Agency Representative

Please see back for checklist of requirement s, fees t o be paid and st eps on OEC Processing.

Balik-Manggagawa Processing of Overseas Employment Certificate

I.Checklist of Requirements (all original)

1.Passport - valid at least 6 months from the date of departure

2.Valid Work Visa / Work Permit or Equivalent Document

3.Proof of Employment returning to same employer

(ie., Employment Contract, Certificate of Employment / Company ID / Pay Slip)

II. Fees:

POEA Processing Fee	P 100	per E-Receipt / OEC
PAG-IBIG Contribution	P 100	minimum amount per month
OWWA Membership Contribution	$25USD	peso equivalent
PHILHEALTH Contribution	P 1,200	one year coverage

III.Procedures:

A. For Walk-in Clients:

Step 1. BM Information sheet

»Get a BM Form at the issuance counter at the POEA entrance. A queuing number is indicated in the Info Sheet. Fill out the BM Information Sheet and proceed to the Balik Manggagawa Service Area and wait for your number to appear on the queuing machine.

Step 2. Evaluation

»Once your number is displayed on the queuing machine, proceed to the Evaluation Counter and present the documentary requirements for evaluation / approval and encoding.

»If documents are in order, the evaluator encodes worker's employment details and gives you instructions to proceed to the Assessment / Cashier Counter.

(If documents are deficient, evaluator endorses the BM / WOL to BM Supervisor / Division Chief for further advice on requirements to be complied with).

Step 3. Assesment / Cashier

»Proceed to the Assesment / Cashier Counter to determine the fees and payment. Wait for the release of your E-Receipt / OEC. The E-Receipt/OEC serves as your travel exit clearance and entitles you to exemption from payment of travel tax, terminal fee and documentary stamps for your remittance transactions.

B.By Appointment System

Step 1. Scheduling

»Log-in at the POEA website www.poea.gov.ph and click the link to BM Appointment System.

»At the BM Appointment System page, choose the Office or Branch where you want to transact and process OEC/E-Receipt. The system will display the available dates. Click the date of your choice and the available time slot will appear. Click your preferred time slot.

»Once date and time have been choosen the BM Info Sheet will be displayed. Fill out the entries and ensure to declare your information accurately and truthfully. Click SUMBIT and a "BM Information Sheet" in Portable Document Format (PDF) will be displayed. Please print in two (2) copies.

Step 2. OEC Processing

»Proceed to the selected processing center at your scheduled date and time for the processing of your OEC / E-Receipt. Please bring with you all the documentary requirements including the printed BM Information Sheet.

M araming salamat po

M aligayang paglalakbay !