8/17/22, 7:54 PM NBI CLEARANCE

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE

NATIONAL BUREAU OF INVESTIGATION

NBI CLEARANCE APPLICATION FORM

 REFERENCE NUMBER

FREITNII43
Tuesday Aug 02, 2022 AM

Valid Until Aug 17, 2022

()
APPLICANT TYPE
1. ID PRESENTED
2. PURPOSE TYPE
3. PURPOSE APPLICATION

NEW PHILHEALTH| LOCAL MULTI-PURPOSE CLEARANCE

BASIC INFORMATION

5. FAMILY NAME
6. HUSBAND FAMILY NAME (FOR MARRIED WOMAN ONLY)

EGAMINO -

7. GIVEN NAME
8. MIDDLE NAME
RHEA JOY ALFONSO

9. NICKNAME
10. OTHER NAME/ALSO KNOW AS

YANG -

11. DATE OF BIRTH

12. BIRTH PLACE

10/23/1999 CALOOCAN CITY

13. CITIZENSHIP
14. GENDER
15. CIVIL STATUS

FILIPINO FEMALE SINGLE

16. SPOUSE
17. BIRTH PLACE

- -

18. PRESENT ADDRESS

BLOCK 5 LOT 5 BAGONG SIBOL ST, CALOOCAN CITY

19. CONTACT NUMBER

20. EMAIL ADDRESS
21. IDENTIFYING MARKS

09753386106 rheajoy.egamino@gmail.com MOLE IN RIGHT EYE

ADDITIONAL INFORMATION

22. HEIGHT 23. WEIGHT 24. COMPLEXION

25. RELIGION

157 56 FAIR ROMAN CATHOLIC

26. EDUCATIONAL ATTAINMENT

27. OCCUPATION

COLLEGE GRADUATE -

PARENTS INFORMATION

28. NAME OF FATHER 29. FATHER BIRTH PLACE

JOEL VALDEZ EGAMINO MANILA

30. NAME OF MOTHER 31. MOTHER BIRTH PLACE

LEAH LUNA ALFONSO MANILA

I certify that I have read and understood all the questions set forth in this application and answer I have furnished on this form are true and correct to the best acknowledge and belief. I understand that any false or
misleading statement is FALSIFICATION PUNISHABLE UNDER ARTICLE 171 & 172 OR REVISED PENAL CODE

________________________________ ________________________________

36. DATE 37. SIGNATURE

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