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Name of OFW:
Address:
Country:
Passport #:
Recruitment Agency:
Employer:
Date Last Contacted:
Relationship to OFW:
Your Email:
Your Contact #:
Details:
Type of Abuse:
Maltreatment/Mistreatment
Health/Medical Problems
Personal Problems
Sexual Harassment/Rape
Immigration Related Problem
Poor Working/Living Condition
Delayed Salary/Non-Payment
Other
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