Republic of the Philippines

SOCIAL SECURITY SYSTEM 34-8900064-4

PERSONAL RECORD

Basic Information

Name of Applicant: ALFORQUE, MARY GRACE BIERNES

Date of Birth: 11/17/1989 (mm/dd/yyyy)

Gender: FEMALE

Marital Status: MARRIED

Nationality: FILIPINO

Religion: CHRISTIAN

Place of Birth: AURORA ZAMBOANGA DEL SUR PHILIPPINES

Home Address: BAYBAY SANTA CRUZ OZAMIS CITY MISAMIS OCCIDENTAL 7200

Telephone No:

Mobile No: (0950) 102-2983

Email Address: marygracealforque29@gmail.com

Name of Father: BIERNES, CESARIO DOREMON

Name of Mother: BONDAUG, PAULINA MANICO

Beneficiary(ies)

Spouse: ALFORQUE, RODULFO RASONABLE

Child: ALFORQUE, JANDI BIERNES 03/02/2012

ALFORQUE, JEWEL GRACE BIERNES 11/02/2013

ALFORQUE, JELIAN BIERNES 11/30/2015

ALFORQUE, JENIEL BIERNES 06/12/2019

Other Beneficiary/ies: TEJANO, ESTRELLITA BIERNES (Sister) 11/29/1972

Purpose of Application

Purpose: FOR EMPLOYMENT

Applicant's Certification

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Signature Over Printed Name Date LEFT THUMB MARK RIGHT THUMB MARK

TO BE FILLED OUT BY SSS

EVALUATED BY:

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Signature Over Printed Name Date Time Branch