MIS Form No.

08-01

PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

Government Service Insurance System
Financial Center, Roxas Boulevard, Pasay City

Latest 1 x1
ID Picture
MEMBERSHIP INFORMATION SHEET (within the last three
months)

PERSONAL DATA :

Name :
Last Name First Name Middle Name Appelation
Sex : Civil Status : Date of Birth :

Place of Birth : TIN : Religion :

Residential Address :

No./ Street/ Barangay Town/ District City/ Province Zip Code/ Region Tel No.
Cellphone No. : E-Mail Address :

Position Title : Status of Appointment :

(Permanent, Termporary, Contractual, etc.)
Basic Monthly Salary : Date of Original Appointment :

Agency Name :

Agency Address :

No./ Street/ Barangay Town/ District City/ Province Zip Code/ Region Tel No.

For DepEd Personnel Only :

Division No. : Station No. : Employee No. :

For GSIS Personnel Only : For Uniformed Personnel Only :

Employee No. : Serial No. :

Attested:

Signature of Member (Signature over Printed Name)

Personnel / Administrative Officer