June 26, 2023

Dear Sir / Madam:

Good day!

I, Rechel C. Lumangtad, hereby authorize Rhine Susbilla, my husband, to process the inclusion of
Samantha Lumangtad Susbilla as one of the beneficiaries in my PhilHealth account. Attached herewith
are my PhilHealth details:
Name: Rechel C. Lumangtad
PhilHealth ID: 17-050332542-2
Membership Type: Indigent
I understand that this entails the necessary documentation and completion of the required forms to
ensure Samantha's coverage under my PhilHealth benefits. I acknowledge that Rhine Susbilla is acting
on my behalf and has my full consent to provide all the necessary information and complete any
required forms during the process. I trust that Rhine Susbilla will fulfill all the necessary obligations and
requirements as per PhilHealth guidelines.
Should there be any further requirements or procedures needed, please inform Rhine Susbilla
accordingly, and he will handle the matter on my behalf.
Thank you for your attention to this matter. I look forward to your positive response.

Yours sincerely,

RECHEL C. LUMANGTAD