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MDR 010265652269

This document is a Member Data Record from the Philippine Health Insurance Corporation providing basic information about a member. It lists the member's PhilHealth Identification Number, member category as part of the informal economy in the informal sector, and personal details such as name, date of birth, address, and contact information. No dependent or employer information is included, as the sections are marked "N/A" or "NOTHING FOLLOWS". The record is signed by the NCR South Las Piñas branch manager and reminds the member to check for errors and safeguard the original copy.

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Joshua Radoc
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78 views1 page

MDR 010265652269

This document is a Member Data Record from the Philippine Health Insurance Corporation providing basic information about a member. It lists the member's PhilHealth Identification Number, member category as part of the informal economy in the informal sector, and personal details such as name, date of birth, address, and contact information. No dependent or employer information is included, as the sections are marked "N/A" or "NOTHING FOLLOWS". The record is signed by the NCR South Las Piñas branch manager and reminds the member to check for errors and safeguard the original copy.

Uploaded by

Joshua Radoc
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


Corporate Action Center Hotline - (02) 441-7442
www.philhealth.gov.ph

MEMBER DATA RECORD


MEMBER BASIC INFORMATION
PhilHealth Identification Number (PIN) : 01-026565226-9 PhilSys Number :
Member Category : INFORMAL ECONOMY -
Sub-Category INFORMAL SECTOR NHTS Coverage : N/A
Validity Period : N/A - N/A

NIEGAS, IYESSA LEGASPI


114 ABRIL ST SILVERIO COMP SAN ISIDRO, PARANAQUE CITY FOURTH DIST.

Foreign Address : N/A Sex : FEMALE


Date of Birth : 07/14/1999
Place of Birth :
Contact No. (Foreign) : N/A Civil Status : SINGLE
(Local) : N/A Tax Identification Number :

ENTITY INFORMATION
PhilHealth Number (PEN/POGN) : N/A
Name of Employer/Organized Group : N/A
hidden text
Business Address : N/A
hidden text
Telephone Number : N/A Employment Status :
Tax Identification Number : N/A Date : N/A

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
*** NOTHING FOLLOWS ***

DR. RAUL B. TUQUERO


Branch Manager
NCR South Las Piñas

Paalala: Basahin ang nilalaman ng MDR. Kung may kulang o mali, ibalik agad upang 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 MDR and do not hand it over to anybody. Provide photocopy to hospital in case of confinement and
availment of benefits.)
This is a Member Portal System generated report. Signature is not required.
Nov 08, 2023 11:37 AM

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