COMMISSION ON FILIPINOS OVERSEAS

INFORMATION SHEET FOR OVERSEAS-BASED FILIPINO EMIGRANTS DIRECTIONS: Print all data legibly in block letters Put an "X" in appropriate boxes to indicate answers Do not fill up section marked "For CFO Use Only" PERSONAL DATA Sex: ( )Male ( )Female

ID PICTURE

Name (Last, First, Middle)

If married, state maiden name:_________________ Place of Birth (Municipality/City/Province) Age Date of Birth MO DAY YR Permanent Address in the Philippines (Street/Barangay/Municipality/City/Province)

Civil Status ( ) 1- Single ( ) 4-Separated ( ) 2- Married ( ) 5-Divorced ( ) 3- Widow/er Ethno-Linguistic Group (Tagalog, Ilocano, Bisaya, etc)

Contact Number (Cellphone or Telephone Number) E-mail Address Relationship Cellphone/Telephone Number E-mail Address

Name of Nearest Relative in the Philippines

Complete Address of Relative Highest Educational Attainment ( ) No Formal Education ( ) High School Level ( ) Elementary Level ( ) High School Graduate ( ) Elementary Graduate ( ) Vocational Level

( ) Vocational Graduate ( ) Post Graduate Level ( ) Others ________________ ( ) College Level ( ) Post Graduate ( ) College Graduate ( ) Not of Schooling Age (below 7 years old) If Vocational/College/Post Graduate, please specify degree obtained ________________________________

Economic Status (Within the Past Six Months) ( ) Unemployed If not working: ( ) Housewife/Househusband ( ) Minor (below 7 yrs old) ( ) Student ( ) Retiree ( ) Out-of-School Youth ( ) Others Passport Number Date of Issue Port of Exit (please state country)

( ) Self-employed

( ) Employed

If self-employed or employed, please state profession / occupation / business ____________________________ Visa Number Date of Issue

Length of Stay in Present Country of Residence ( ) 5 years or less ( ) 6-10 years Immigration Status in Present Country of Residence ( ) Tourist ( ) Overseas Filipino Worker ( ) Permanent Resident Complete Address in Country of Destination PETITIONER DATA Name of Petitioner (Last, First, Middle) Relationship with Petitioner Complete Address of Petitioner Abroad Age Occupation

( ) 11-15 years ( ) Naturalized Citizen

( ) 16 years or more ( ) Others ________________ Contact Number

If petitioned by company or employer, please supply information below Employer/Company

Address of Employer/Company Citizenship Civil Status of Petitioner Occupation E-mail Address Telephone Number Recruiting Agency Address of Recruiting Agency

Year of Migration FOR CFO USE ONLY ( ) Spouse of foreign national ( ) Investor ( ) Fiance(e) of foreign national ( ) Non-immediate relative of foreign ( ) Child of Filipino married tot foreign national or Filipino citizen ( ) Child of former Filipino citizen ( ) Child of foreign national ( ) Spouse of Filipino immigrant ( ) Non-immediate descendant of foreign ( ) Child of Filipino immigrant citizen ( ) Ffiance(e) of Filipino immigrant ( ) Parent of former Filipino citizen ( ) Brother/sister of former Filipino citizen ( ) Parent of Filipino immigrant ( ) Co-sponsored immigrant ( ) Adopted child ( ) Spouse of co.-sponsored immigrant ( ) Veteran ( ) Child of co.-sponsored immigrant ( ) De facto relationship ( ) Principal immigrant ( ) Others ( ) Spouse of principal immigrant ( ) Spouse of former Filipino citizen ( ) Child of principal immigrant ( ) Fiance(e) of former Filipino citizen ( ) Special immigrant ( ) Child of the spouse of a former Filipino citizen FOR CFO USE ONLY ENCODER DATE OF ENCODING (This Form Is Not for Sale)

CERTIFICATION I hereby certify under penalty of law to the truth and the correctness of the statement and that this form was accomplished by me personally or under my personal direction.

__________________________ Printed Name and Signature