Republic ofthe Philippines PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN (GOVERNMENT SERVICE INSURANCE SYSTEM) ‘Tuguegarao Branch Office Cais Carig Sur, Tuguegarao City ‘Tel/Fax No, 396.0650/396-0673 ACTIVE MEMBER TEMPORARY ECARD ACTIVATION FORM. Date:_02 ar /2071 Gsis 1p No. _[)45 4316732 umip/ecaro caro no. 4!) 9802 7938 3920 Personal Information Tastee TAN BANA FINI WAY OY waseNane UCB Sufixtie Sr Jel, ete) Gander Date oa MDOT) Ine Tg F Cw siaus Nf Residence Address/Contact Information reas De JUL ST. PUROE © BULANAD TABUK CIM, KALINGA watterCoTehone Ne. DATT YUAN (04. ¢2 744227 Aomertene DEPACTMENT DF EPMCATION lValid IDs Presented company Ono prone QACDSA —_vtersi0 no Pogtio No. sss no. Passport No. er TIN. 4 |-09-h12-POOs a) ignature) CERTIFICATION This to certify that | have [1 seen the above member and validated the identity of the member through the IDs presented (delivered the eCard to the member | also certify thatthe information herein provided was taken by the undersigned personally and freely given by the member. Validated by: Activated by: Jeelady B. Isaac Lesu Branch ManagerRepublic ofthe Philippines PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN (GOVERNMENT SERVICE INSURANCE SYSTEM) ‘Tuguegarao Branch Office GSIS ‘Carig Sur, Tuguegarao City ‘Tel/Fax No, 396-0650/396-0673 ACTIVE MEMBER TEMPORARY ECARD ACTIVATION FORM. Date:_02 ar /2071 esis ip no. _[)40£4316730 umip/ecarD carb No. 41¢2 94802 7438 3020 [Personal Information Tosrnare TANG DANIAN Feiner _Atf Jty) Tia Wi LWCOB ‘Saiz ie Sr Jel, ete) Danae UDO HIDE AAS Gender Guise Nf Residence Address/Contact Information moses De JESUS $7, PUROE C BULANAD TABUK CIM, KALINGA Webieroabhore Ne. DATT GUD AED (D4DG2744227 Aosrey Nene DEPALT MENT DF FPUCATION lValid IDs Presented Company Ono. prone (DACDS4 —_vters10 no Pagtig No ass wo Passport No. ere Tn No. Ye /-009-h02-POOs ee) ignature) CERTIFICATION ‘This to certify that Ihave [9 seen the above member and validated the identity of the member through the IDs presented (1 delivered the eCard to the member | also certify thatthe information herein provided was taken by the undersigned personally and freely given by the member. Validated by: Activated by: Jeelady B. Isaac LESU Branch Manager