ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Republic of the Philippines
FORM NO. 5
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DEPARTMENT OF LABOR AND EMPLOYMENT
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Regional Office No. ___
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MONTHLY REPORT ON THE ISSUANCE OF CERTIFICATE OF EXCLUSION
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No.Name of Alien
(Foreign National)		NationalitySex
(M/F)		Category/ies
Type of
Visa		PositionName of
Company		Company
Address		Nature of
Industry		Certificate/Card
Number		Date FiledDate IssuedValidity Period
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FromTo
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Prepared by:Reviewed by:Approved by:
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Name, Position/DesignationTSSD ChiefRegional Director
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