Company Name: LALA NATIONAL HIGH SCHOOL

Address: LALA, PAGADIAN CITY

School ID: 303901

GRADE 12 STUDENTS
LAST NAME GIVEN NAME MIDDLE INITIAL
1 ABALLE CHARLIES JR. M.
2 ACALAIN MARDY M.
3 CABALLES JUNREL P.
4 COLANSE AARON JHON B.
5 CUPAT JERSON M.
6 DIMPASO MIKE LLOYD C.
7 DIONALDO EDMAR L.
8 DUMPA ROTCHEL H.
9 GALANG CYRELJAMES E.
10 GEMINA ANDREWAREN A.
11 INFERIDO JAMESKIRBY A.
12 JERUSALEM JUVIN J.
13 LOBITAÑA CHOLO B.
14 SIABO BERNADEL T.
15 SORDILLA ERNESTO JR. B.
16 ABILA MARYELLE I.
18 BODIONGAN GLADY MAE R.
19 BODIONGAN LADY JANE B.
20 DACOL SHIENA MAY C.
21 GANDALON JHONNA MAE A.
22 GOMONIT ANNABELLE Y.
23 GUADALQUIVER MARYJOY L.
24 LAGARE JENNY M.
25 LAÑA JASMINCLAIRE T.
26 LEGONAS SHERLEN L.
27 LEPARTO RENEROSE T.
28 MAGHANOY ELLA JANE D. D.
29 MALALAY LADY JEAN B.
30 SERASPI ANLYN C.
31 TAMPOS RHENNA MAE L.
32 ANDILAB MARK M.
33 BAARDE LAWRENCE M.
34 BRUCE RHINCE IAN M.
35 DODO ALVIN L.
36 DONAL MELVIN JAY C.
37 HAGONUS REGIE GLEN F.
38 LEGASPI ERNESTO JR. T.
39 LOMONGO MARK JOVEN T.
40 LUMILIS MELDRED B.
41 MELLORIN JOHN RHIX G.
42 OLAGUERA VINCE EMMANUEL R.
43 PUEBLAS LESTER G.
44 SAMMARA DISAN E.
45 TUADA REXIS JR P.
46 JOVANNIE JOVANNIE M.
47 YBAÑEZ JEROME B.
48 ZAMBALE REY JOHN T.
49 ABO-ABO SWEET ANGEL G.
50 AMARO MARY ANN N.
51 BUSTAMANTE APPLE GRACE T.
52 CALIB-OG ANGEL MAE D.
53 CANTAON SHAINA MAE B.
54 COCA RHUSMER R
55 DOMINGUEZ LIZA MAY B.
56 DUMABOC CHENAMAE A.
57 DUMABOC CHRYSEL JOY G.
58 DUMABOC CYNDE I.
59 GUEVARRA LEZLY B.
60 MANALO HAZEL PAULA L.
61 MARTINET WYSRILLFAITH O.
62 ORIL CLARA JANE R.
63 TEJADA CHERRY MAE T.
64 TUMATAO MIRAFE D.
65 WATIMAR AIMEE S.
66 BALANSAG CHIMEL D.
ATIONAL HIGH SCHOOL
AGADIAN CITY

DATE OF BIRTH GENDER MARITAL STATUS BENEFICIARY

mm/dd/yyyy M/F SINGLE/MARRIED LAST NAME, GIVEN NAME, MIDDLE NAME
2/18/2005 MALE SINGLE ABALLE,CHRISTINE MALINAO
4/18/2004 MALE SINGLE ACALAIN, MARLO MANLAWE
6/23/2003 MALE SINGLE CABALLES, JOEL LUMANOG
11/25/2005 MALE SINGLE BODIONGAN,LUCIA PAQUINOL
6/1/2006 MALE SINGLE CUPAT,JENECITA MAGHINAY
8/11/2003 MALE SINGLE CAYMAN,GRECEL ACAIN
9/10/2004 MALE SINGLE DIONALDO,MERLYN SORDILLA
9/12/2002 MALE SINGLE DUMPA,ANALIZA HABAGAT
6/8/2005 MALE SINGLE ENERIO,ANALIZA CALIZA
08/22/2004 MALE SINGLE PABLITO,GEMINA CARACUT
12/1/2005 MALE SINGLE PACATANG,JEAN ANUB
1/9/2004 MALE SINGLE JERUSALEM,JOLY JUEVAS
06/25/2005 MALE SINGLE LOBITAÑA, ANNA LISA BRIONES
05/19/2002 MALE SINGLE SIABO,MICHILLE TACTACON
08/20/2005 MALE SINGLE SORDILLA,ERNESTO BETACURA
08/15/2005 FEMALE SINGLE ABILA, MITZEL IROG-IROG
10/23/2005 FEMALE SINGLE BODIONGAN,JUJIT PANG-AN
7/2/2005 FEMALE SINGLE BODIONGAN,JELLY ROSA BUHAYAN
05/22/2005 FEMALE SINGLE DACOL,EVELYN CUPAT
02-Apr FEMALE SINGLE GANDALON,ANALIZA ARADO
04/25/2005 FEMALE SINGLE YAGO,ELSIE BUSTILLO
12/11/2005 FEMALE SINGLE MARITES,CAMPILAN GUADALQUIVER
01/31/2005 FEMALE SINGLE LAGARE,JOSIPHINE MARIÑO
12/4/2005 FEMALE SINGLE LAÑA,ELYNE TUMALA
06/30/2005 FEMALE SINGLE LEGONAS,CHERLITA LUMIGAO
10/8/2005 FEMALE SINGLE LEPARTO,ROSALIE TAMPOS
08/16/2004 FEMALE SINGLE MAGHANOY,JOCELYN DABIN
04/23/2004 FEMALE SINGLE MALALAY,DAYIN BAYONA
07/27/2005 FEMALE SINGLE LAGNASAN,JOCELYN DIONALDO
1/5/2005 FEMALE SINGLE TAMPOS,CHARINA LIBRADILLA
09/25/2002 MALE SINGLE ADNILAB,ISABELITA MATCHUCA
03/25/2005 MALE SINGLE MANSING,LUCIA TAO-TAO
10/16/2002 MALE SINGLE BRUCE,ELIZABETH MAGKILAT
MALE SINGLE
12/5/2003 MALE SINGLE DONAL ,ANACLETO BUSTAMANTE
10/24/2005 MALE SINGLE HAGONUS,NERIE FAMOR
12/27/2003 MALE SINGLE
11/9/2002 MALE SINGLE LOMONGO,NIRESSA TORMIS
MALE SINGLE
MALE SINGLE
5/3/2005 MALE SINGLE EMBUDO,CONCEPCION ABEAR
02/23/2005 MALE SINGLE PUEBLAS,ROSELYN GABONADA
10/17/2003 MALE SINGLE SAMMARA,JOSEPHINE EMPREZA
12/24/2004 MALE SINGLE
09/27/2003 MALE SINGLE TUTAS, ARSENIA MANIT
04/27/2004 MALE SINGLE MURGADO,GINA YBAÑEZ
04/15/2004 MALE SINGLE ZAMBALE.RIZA TANO
6/9/2005 FEMALE SINGLE ABO-ABO,CECILIA GUTIERREZ
FEMALE SINGLE
6/6/2005 FEMALE SINGLE BUSTAMANTE.NARDO PACIFICO
10/19/2004 FEMALE SINGLE CALIB-OG,ESTRELLITA DECLANAN
11/20/2005 FEMALE SINGLE CANTAON,PERLITA,BACARO
5/12/2004 FEMALE SINGLE COCA,HERMINIA REVILLA
09/21/2004 FEMALE SINGLE DOMINGUEZ,JOVEN YURONG
05/18/2004 FEMALE SINGLE DUMABOC,LEONCIO MALALAY
5/6/2005 FEMALE SINGLE DUMABOC,PABLITO HIOCO
2/2/2005 FEMALE SINGLE DUMABOC.THELMA INGGAY
03/23/2004 FEMALE SINGLE GUEVARRA,ROGER,HECALI
01/17/2005 FEMALE SINGLE MANALO,JEAN LAGARE
09/20/2004 FEMALE SINGLE LUZON,EDITHA TAOC
09/27/2004 FEMALE SINGLE ORIL, BENANCIO BAYOT
1/4/2004 FEMALE SINGLE TEJADA,SOLEDAD PLAZA
3/4/2005 FEMALE SINGLE TUMATAO,ERLINDA BADAYOS
03/27/1999 FEMALE SINGLE
04/25/2005 FEMALE SINGLE BALANSAG, IMELDA DUMABOC
 BENEFICIARY
LAST NAME, GIVEN NAME, MIDDLE NAME
ABALLE,CHRISTINE MALINAO
ACALAIN, MARLO MANLAWE
CABALLES, JOEL LUMANOG
BODIONGAN,LUCIA PAQUINOL
CUPAT,JENECITA MAGHINAY
CAYMAN,GRECEL ACAIN
DIONALDO,MERLYN SORDILLA
DUMPA,ANALIZA HABAGAT
ENERIO,ANALIZA CALIZA
PABLITO,GEMINA CARACUT
PACATANG,JEAN ANUB
JERUSALEM,JOLY JUEVAS
LOBITAÑA, ANNA LISA BRIONES
SIABO,MICHILLE TACTACON
SORDILLA,ERNESTO BETACURA
ABILA, MITZEL IROG-IROG
BODIONGAN,JUJIT PANG-AN
BODIONGAN,JELLY ROSA BUHAYAN
DACOL,EVELYN CUPAT
GANDALON,ANALIZA ARADO
YAGO,ELSIE BUSTILLO
MARITES,CAMPILAN GUADALQUIVER
LAGARE,JOSIPHINE MARIÑO
LAÑA,ELYNE TUMALA
LEGONAS,CHERLITA LUMIGAO
LEPARTO,ROSALIE TAMPOS
MAGHANOY,JOCELYN DABIN
MALALAY,DAYIN BAYONA
LAGNASAN,JOCELYN DIONALDO
TAMPOS,CHARINA LIBRADILLA
ADNILAB,ISABELITA MATCHUCA
MANSING,LUCIA TAO-TAO
BRUCE,ELIZABETH MAGKILAT

DONAL ,ANACLETO BUSTAMANTE

HAGONUS,NERIE FAMOR
LOMONGO,NIRESSA TORMIS

EMBUDO,CONCEPCION ABEAR
PUEBLAS,ROSELYN GABONADA
SAMMARA,JOSEPHINE EMPREZA

TUTAS, ARSENIA MANIT

MURGADO,GINA YBAÑEZ
ZAMBALE.RIZA TANO
ABO-ABO,CECILIA GUTIERREZ

BUSTAMANTE.NARDO PACIFICO
CALIB-OG,ESTRELLITA DECLANAN
CANTAON,PERLITA,BACARO
COCA,HERMINIA REVILLA
DOMINGUEZ,JOVEN YURONG
DUMABOC,LEONCIO MALALAY
DUMABOC,PABLITO HIOCO
DUMABOC.THELMA INGGAY
GUEVARRA,ROGER,HECALI
MANALO,JEAN LAGARE
LUZON,EDITHA TAOC
ORIL, BENANCIO BAYOT
TEJADA,SOLEDAD PLAZA
TUMATAO,ERLINDA BADAYOS

BALANSAG, IMELDA DUMABOC

 RELATIONSHIP

MOTHER
FATHER
FATHER
GRANDMOTHER
MOTHER
MOTHER
MOTHER
MOTHER
MOTHER
FATHER
AUNT
MOTHER
MOTHER
MOTHER
FATHER
MOTHER
FATHER
MOTHER
MOTHER
MOTHER
GRANDMOTHER
MOTHER
MOTHER
MOTHER
MOTHER
MOTHER
MOTHER
MOTHER
MOTHER
MOTHER
MOTHER
GRANDMOTHER
MOTHER

FATHER
MOTHER
 MOTHER

GRANDMOTHER
MOTHER
MOTHER
FATHER
MOTHER
AUNT
MOTHER
GRANDMOTHER

FATHER
MOTHER
MOTHER
MOTHER
FATHER
FATHER
FATHER
MOTHER
FATHER
MOTHER
GRANDMOTHER
FATHER
GRANDMOTHER
MOTHER

MOTHER
NEW BUSINESS - CENSUS LIST FOR GROUP APPLICATION
Company Name:
if with sub office, Sub Office Company Name:
Policy Number:
Product Name:
Effective Date:
Payment Mode:

MEMBER DETAILS:
Fill each column with accurate member details.
ALL FIELDS ARE REQUIRED except for UNIQUE IDENTIFIER

LAST NAME
COMPANY NAME GIVEN NAME MIDDLE INITIAL
Include suffix if applicable
Jr./Sr./II/III
Example: ABC COMPANY Dela Cruz Juan A

ABC COMPANY Dela Cruz Maria A

PPLICATION

DATE OF BIRTH GENDER MARITAL STATUS JOB LEVEL

mm/dd/yyyy Male/Female Single/Married/Widow Owner/Executive/Manager/R&F

1/1/1994 Male Single Manager

 UNIQUE IDENTIFIER
AMOUNT OF AMOUNT OF
SPECIFIC JOB TITLE
Fill if available with COVERAGE PREMIUM
Employee No./TIN/SSS No.
Operations Manager E#0001 100,000.00 500.00
DEPENDENT DETAILS
Fill each column with accurate member details.
ALL FIELDS ARE REQUIRED except for UNIQUE IDENTIFIER

DEPENDENT LAST NAME

DEPENDENT GIVEN NAME DEPENDENT MIDDLE INITIAL
Include suffix if applicable
Jr./Sr./II/III
DELA CRUZ JUAN - DEPDENDENT 1
DELA CRUZ JUAN - DEPDENDENT 2
DELA CRUZ JUAN - DEPDENDENT 3
DELA CRUZ MARIA - DEPENDENT 1
DELA CRUZ MARIA - DEPENDENT 2
 DEPENDENT
DEPENDENT DATE OF BIRTH DEPENDENT GENDER
MARITAL STATUS

mm/dd/yyyy Male/Female Single/Married/Widow

DEPENDENT'S RELATIONSHIP
TO PRINCIPAL DEPENDENT AMOUNT DEPENDENT AMOUNT
OF COVERAGE OF PREMIUM
Parent/Spouse/Child/Sibling