catherine vulgpie neat te iNouRANCE CORPORATION ARTERY a (GF olen Pak Teer, Coro eco to St, Cebu iy 00 Gasca ay ey 993.7573 G32) 223 3287 (an (032) 233 3281 (032) 233 7671 Sawee prima. goto MEMBER DATA RECORD MEER BASICINFO Siti SS a PhilHiealth Identification Number (PIN) : 0305037706 PhilSys Number : Member Category DIRECT CONTRIBUTOR - SELF EARNING INDIVIDUAL - INDIVIDUAL NHTS Coverage NA Validity Period NA “AAMITAG, JOSETH ARMELL SIRON TIO PALACULAN WAWA, NASUGBU. BATANGAS - 4231, reign Address NA Sex MALE Date of Birth 9720/1987 Place of Birth NCR, CTY OF MANILA FIRST DISTRICT fomtact No. (Foreign): NIA Civil Status SINGLE Local) 109686505003 253152097 NITYINFORMATION Peg okay sihealth Number (PEN/POGN) NA ame of Employer/Organized Group: NA wsiness Address NA lephone Number NA Employment Status : N/A ‘x Identification Number NA Date 2 NIA MARJORIE A. CABRIETO REGIONAL VICE PRESIDENT PRO - VI Cebu City Paalala : Basahin ang nilalaman ag MOR. Kung may kulang o mali ibalik agad upang maidagdag o maiwasto. Ingatan ang ovhinal a kopya at huwag ibigay kahit kanino, Kung sakaling gagamit at makikinabang ng benepisyo, maghigay ng kopya sa ospital. Remade: nd he contr of be MOR. Sal thre ay dts dcrepances, remake oc the ea, Tak ged eae fhe MOR an do ma hind nero anybody rom pocpy opin case fanaa aime beets) This is a system generated report. Signature isnot required. ‘primed 6: PRO VI Cebu Gy Bi olden Pek Tor, Cord Ae cor. xi St, Cob iyPrinted by: NATIONAL PRINTING OFFICE Diliman, Quezon City TN 00-768-754-000 ® @ Revised October 2008, fi Zip Codes. sTel Noss se cee emt eee ceo PHILHEALTH OFFICIAL RECEIPT Republic of the Philippines = Philippine Health Insurance Corporation ) ‘Seatac PORE Dare | yo. 99108901 01/18/2023 Received from: _MAMITAG, JOSETH ARMELL SIRON Reference: __iNDIVIDUALLY PAYING (SELF EARNING IND.) NATURE OF COLLECTION AMOUNT PYA-CONTRIBUTION-INFORMAL SECT 1,200.00 for Oct 1 - Dec 31, 2022 Totar > | F AMOUNT IN WORDS One thousand two hundred and 0/100 pesos cass Drawee Bank Number Z Date 1D Check [Money order Premium Dover for: “Received the Amount Syhted Above, Billing Statement Not - JOAN MAE. KHO cm Billing Date: COLLECTING OFFICER ‘ORNGG 108001 TRANS 00057 JLK 18-Jur2023 09.26uin1 P 1,200.00 CA 1200230 1 16000676244900B9 1040 1#4904428B0690 PRO-VII Regional Offce) GF GOLDEN PEAK TOWER, GORODO AVE. COR. ESCARIO S1,0EBU CITY PAYOR’S COPY : ee >