Republic of the Philippines Department of labor and Employment

NOT FOR SALE

(May be reproduced)

Overseas Workers Welfare Administration Education and Training Benefits Skills-for-Employment Scholarship Program (SESP)
Regional Welfare Office 3
APPLICANTS DATA: Name: Sex: LAST Civil Status FIRST Birthdate MIDDLE Birthplace: Tel/CP No.

Attach a recent 1 x 1 photo here

Application No.__________

Age:

Permanent Address: Relation to OFW: Highest Educational Attainment: School: Course: Duration:

Address/Branch: Tuition Fee:

OFW DATA
Name of OFW: Sex: Agency: Position: Date of latest OWWA contribution ________________________________________ Applicants Signature DOCUMENTS SUBMITTED: ( ) Diploma, HS Report Card, transcript of Record, PRC License ( ) Proof of OWWA membership ( ( ( ( ) Birth Certificate (NSO) of applicant, if child of OFW Civil Status Birthdate: Employer: Jobsite:

Land-based

Sea-based

Birthplace:

Age:

No. of contribution/s: __________________________ Date

) Birth Certificate (NSO) of both applicant and OFW if brother/sister of OFW & CENOMAR ) Marriage Certificate (NSO) if spouse of OFW ) Others ___TVET ___Course Quotation ___Course Outline Date:____________________________ EVALUATION With program accreditation By:___________________________

RECEIVED BY: ___________________________________ VERIFICATION With previous availment Without previous availment By: _____________________________

Date: ______________

Date: _________________________

RECOMMENDATION: __________________________________ CHIEF, PSD Date: __________________________

APPROVED: ______________________________________ RWO3 DIRECTOR Date: __________________________

Republic of the Philippines Department of Labor and Employment OVERSEAS WORKERS WELFARE ADMINSITRATION Regional Welfare Office 3, City of San Fernando, Pampanga

Affidavit of Undertaking
That I, ______________________________________________, an OFW / a dependent of OFW, ______________________________________, a resident of ____________________________________, and having been awarded a scholarship grant by the Overseas Workers Welfare Administration, do hereby depose and state:

1.

2. 3.

4. 5.

That, in consideration of the benefits and privileges given to me as a scholar, I will strive to the best of my ability and shall work to achieve the objectives of the course that I have chosen; That, I will faithfully comply with the terms and conditions set forth under the scholarship program; That, in case I voluntarily drop-out, be expelled by the school authorities for reasons attributable to my actions or violate any of the terms and conditions of the program, all benefits and privileges under the program in my behalf shall be forfeited and that I am disqualified from reapplication for the same; That, as a consequence thereof, I will reimburse OWWA of all the expenses I incurred, including tuition fees, monthly allowance and other expenses; and That, I accept the foregoing conditions with my full knowledge and have read and understood the same.

SIGNED this ______ day of ______________, 2012, at ___________________________________.

_______________________ Grantee

I, ____________________________________________, an overseas Filipino worker, being the principal beneficiary for the SESP, do hereby waive my right and privilege in favor of my _______________________, __________________________________ and in gratitude of the assistance extended by OWWA to my immediate dependent/beneficiary under the SESP, I obligate myself enable the latter to comply with the terms and conditions set forth in the program. I understand that the non-compliance or willful violation of the program shall cause the forfeiture of the scholarship and to compel me and my dependent-grantee to reimburse to OWWA all expenses incurred by virtue of the grant.

SIGNED this ______ day of ______________, 2012, at ___________________________________.

_____________________________ Overseas Filipino Worker

------------------------------------------------------------------------------------------------------------------------------------------------

SUBSCRIBED AND SWORN to before me this _____ day of ________________, 2012, affiant exhibiting to me his/her Community Tax Certificate No. _________________________, issued at __________________________, on ______________________________.

Notary Public

Doc No. Book No. Page No. Series of