Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Corporate Action Center Hotline - (02)441-7442
MDR
www.philhealth.gov.ph

MEMBER DATA RECORD

MEMBER INFORMATION
Philhealth Identification Number (PIN) : 120514395190
Member Category : FORMAL ECONOMY NHTS Coverage :
Sub-Category : PRIVATE Effectivity Period :

DEL ROSARIO , SHAJARA CANTAL

PROPER SAN ISIDRO, ASTURIAS, CEBU 6042

Foreign Address : N/A Sex : Female

Date of Birth : 12/03/1994
Place of Birth : CEBU CITY, CEBU

Contact No.(Foreign) : N/A Civil Status : SINGLE

(Local) : 09331928141 Tax Identification Number :

EMPLOYER/ORGANIZED GROUP INFORMATION

PhilHealth Number (PEN/POGN) : 200822300005
Name of Employer/Organized Group : ST FRANCIS ACADEMY
Business Address : E S BINGHAY ST STA CRUZ-STO NINO BALAMBAN, BALAMBAN, CEBU

Telephone Number : 3332209

Tax Identification Number : 000259026

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
*** NO DECLARED DEPENDENT/S ***

Paalala: Basahin ang nilalaman ng MDR. Kung may kulang o mali, dalhin agad ang kopya sa pinakamalapit na PhilHealth Office upang maiwasto. Ingatan ang inyong kopya ng MDR
at huwag ibigay kahit kanino.
Reminder: Read the contents of the MDR. Should there be discrepancies, bring your copy to the nearest PhilHealth Office to amend or rectify error. Take good care of the MDR
and do not hand it over to anybody.

This is a Member Inquiry System generated report.

3/27/2019 10:07:50 AM