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Member Data Record: Philippine Health Insurance Corporation

This document is a Member Data Record (MDR) from the Philippine Health Insurance Corporation (PhilHealth) for member Mabellee Polestico Trapalgar. It provides her PhilHealth Identification Number, member category, personal details like name, address, date of birth, and contact information. It also indicates she has no declared dependents under her coverage. The MDR reminds the member to check for any errors or missing information and to keep the original copy safe while providing photocopies when availing of benefits.

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Mabelle Trapalgar
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4K views1 page

Member Data Record: Philippine Health Insurance Corporation

This document is a Member Data Record (MDR) from the Philippine Health Insurance Corporation (PhilHealth) for member Mabellee Polestico Trapalgar. It provides her PhilHealth Identification Number, member category, personal details like name, address, date of birth, and contact information. It also indicates she has no declared dependents under her coverage. The MDR reminds the member to check for any errors or missing information and to keep the original copy safe while providing photocopies when availing of benefits.

Uploaded by

Mabelle Trapalgar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION


880 Estuar Bldg. Quezon Ave., Quezon City
332-1550 332-1551
www.philhealth.gov.ph MDR
MEMBER DATA RECORD
MEMBER INFORMATION

PhilHealth Identification Number (PIN) : 030257975041


Member Category : INFORMAL ECONOMY NHTS Coverage :
Sub-Category : INFORMAL SECTOR Effectivity Period :

TRAPALGAR, MABELLEE POLESTICO


PHASE 2 PUROK 10 LUPANG PANGAKO,
PAYATAS, QUEZON CITY, SECOND
DISTRICT 1119

Foreign Address : N/A Sex : Female


Date of Birth : 09/03/1989
Place of Birth : QUEZON CITY

Contact No. (Foreign) : N/A Civil Status : SINGLE


(Local) : Tax Identification Number :
EMPLOYER/ORGANIZED GROUP INFORMATION
Philhealth Number (PEN/POGN) : N/A
Name of Employer/Organized Group : N/A
Business Address : N/A

Telephone Number : N/A


Tax Identification Number : N/A
DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth

*** NO DECLARED DEPENDENT/S ***

*** NOTHING FOLLOWS ***

ARSENIA B. TORRES
Branch Manager
NCR Central Quezon City

Paalala : Basahin ang nilalaman ng MDR. Kung may kulang o mali, ibalik agad upang maidagdag o maiwasto. Ingatan ang orihinal na
kopya at huwag ibigay kahit kanino. Kung sakaling gagamit at makikinabang ng benepisyo, magbigay ng kopya sa ospital.
(Reminder: Read the
contents of the MDR. Should there be any data discrepancies, return it back to amend or rectify the error. Take good care of the MDR and do not hand it over to anybody.
Provide photocopy to hospital in case of confinement and availment of benefits.)

This is a system generated report. Signature is not required.


6/17/2015 1:23:40 PM 20242400 20242400 / / 6/17/2015

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