Retail Form

Employment Verification

Email* FV Name* Applicant's Name* Given Office Address* Verified Actual Office Address* Company Name* Nature of Business* Contact No.* Company Email Address/Company Web Site* Year's in Business* No. of Employees* Company Office hours and days* Applicant's Employment Status*

CasualContractualProbationaryProject BasedRegularN/A

Date Hired* Year's in Service* Rank/Title*

Doctor/Lawyer/Professors/Administrators/ArchitectsStaffManagerSenior ManagerExecutiveN/A

Position Held* Employment Type*

LocalLess 2 Yrs EmployedOFWRemittanceSeafarerN/A

Name of Vessel (Seafarer)* Crewing/Recruitment officer (Seafarer)* Declared Residence Address per 201 file Compensation Mode

SalaryCommisionNo Information

Monthly Basic Salary* Fixed Monthly Allowance Guaranteed Bonus Other Benefits Annual Salary Administrative Case Type of Loan Loan Monthly Amortization* Outstanding (O/S) Balance* Date Granted* Loan Maturity* Authorized Signatories (Name/Position) - COE* Authorized Signatories (Name/Position) - ITR* Name of Informant / Position / Remarks* CI Result*

Verified OKVerified with AdverseNot VerifiedNon Existent

Other / Remarks Time of Visit*

Picture - Structural*

FV Selfie*

Picture/Signage

Others

Section

ANTI-SUHOL REPORT

Report within 24 hours if you have experienced any form of bribery in kind or in cash while you were conducting verification.

Did you experience any type of bribery? (Material / Food / Money / Favors) Report the incident and any unlawful activities encountered.*

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