Republic ofthe Philippines PHILIPPINE HEALTH INSURANCE CORPORATION (Efnzees Building #786 1 Roroles Avense Butan CX (085) 3419354688, 2257026 local 11102111, 1820) (085) 342 6992 MDR MEMBER DATA RECORD. PhilHealth Identification Number (PIN): 182502949609 (MEMBER INFORMATION, Member Category INFORMAL ECONOMY NHTS Coverage Sub-Category INFORMAL SECTOR Eectvity Period JOSOL, KATHLEEN PABATANG. PUROK 4, BUHANG, MAGALLANES, AGUSAN DEL NORTE 8604 Foreign Address NA sex + Female Date of ith a7ni999 Face o ith Butuan ay, acLsAVoR NORTE Contact No, Foreign) NIA ivi Status SINGLE es (Local Tax Kentcaion Number EMPLOVERORGANIZED GROUP INFORMATION == hilheah Number PEN/POGN) NA Name of tmployerOrganized Group: NIA Bosiness Adres NA i ‘Telephone Number : NA | Tacidentiicason Number NA _ : DEPENDENT INFORMATION, _ | ___sumame Chen ame Widdlesame [Sex| Retaion [ae of tian 7 NO DECLARED DEPENDENTS == | +++ NOTHING FOLLOWS *** MICHAEL JIBSON C. HERNANDEZ. ACTING REGIONAL VICE PRESIDENT PRO CARAGA Butuan City Paatala; Basshin ang elalaman n Konya at hua bay Lait hale eo aay Kalan o mal bak aga upang maldagdag o maiwast.Igatan ang onal na tonne Seren wlincangtg ate tastes ee iat inners rien ant dita go bey lope care ofthe MOR sd do thin 8 ove to anybod. heen et ard avlmert of berets ee amaamt ase sate epor. Sign