Cooperative Health Management Federation Declaration Form AUGUST 2020 List of Enrollees Cooperative Name

COOPERATIVE HEALTH MANAGEMENT FEDERATION
Declaration Form AUGUST 2020

LIST OF ENROLLEES
COOPERATIVE NAME: FIRST COMMUNITY COOPERATIVE- MINTAL B
NOTE: PLEASE USE ALLCAPS WHEN INPUTTING THE ASSURED DETAILS
Name of Insured BirthDate

Age Gender
Last Name First Name Middle Name (mm/day/yr)
1 ABELLANA ALAN KRISHER DIZON 02/09/1974 46 MALE
2 ARANAS HAZEL ANN TOROBA 02/07/1989 31 FEMALE
3 ARGUELLES JESALLE JOY BANZON 09/09/1989 30 FEMALE
4 AUXILIO SADE SLARE ASCAÑO 07/01/1986 34 MALE
5 BESOYO RODERICK SILARAS 05/13/1987 33 MALE
6 CAFE JOAN MONDEJAR 01/26/1993 27 FEMALE
7 CAJES KHENNETH BRYLLE MENDOZA 12/27/1991 28 MALE
8 CARDOZA CECILIA DIOSO 12/19/1965 54 FEMALE
9 CUESTAS RONAN REY LABOR 08/21/1985 35 MALE
10 DAO-ON DHAN MICHAEL LIBANTE 03/30/1987 33 MALE
11 DIEGO JAYPEE CANIDO 12/02/1996 23 MALE
12 ELLACER EHELDA SIMBLANTE 05/29/1976 44 FEMALE
13 ESPINA CRISANTA FELIPE 10/11/1959 60 FEMALE
14 GALVEZ EVELYN NAOL 01/21/1973 47 FEMALE
15 HAMILI JOCELYN HALASAN 02/24/1973 47 FEMALE
16 HERMOSO ANECITO JR BANTASAN 11/23/1978 41 MALE
17 HERNANDEZ ANALENE FETALVER 12/31/1969 50 FEMALE
18 HUETE FELINA DIOSO 03/24/1963 57 FEMALE
19 INCORPORADO MARIA LOURDES SARON 02/11/1964 56 FEMALE
20 JAPAY ROSALINDA PENONIA 06/04/1967 53 FEMALE
21 JESTO FLORDELIZA QUIJANO 08/15/1972 48 FEMALE
22 LAGAS NOEL 03/23/1963 57 MALE
23 LAGRADA LORETTA ABAD 10/23/1976 43 FEMALE
24 LUGSANAY ARCILYN PULLAN 11/21/1973 46 FEMALE
25 MANGLICMOT MARK GANZON 09/09/1996 23 MALE
26 MIGALBIN MA. ELENA PAGARAN 03/01/1966 54 FEMALE
27 NABASCA CRISTINE TAYLARAN 05/11/1990 30 FEMALE
28 OCAMPO DINA VERGARA 12/26/1988 31 FEMALE
29 PAGARAN MARCOS PAUSANOS 06/04/1973 47 MALE
30 PENUELA JANETH LUMIKID 02/12/1980 40 FEMALE
31 PEREZ ALET MATA 07/30/1986 34 FEMALE
32 PEREZ CATHERYN SIACOR 04/11/1980 40 FEMALE
33 PULPUL CHARO LAMBENACIO 02/01/1984 36 FEMALE
34 RALLON JULIANA MEJORADA 02/16/1958 62 FEMALE
35 TE JESSAMINE CANONIGO 10/27/1981 38 FEMALE
36 TORREGOSA EDITA FALLADO 06/08/1972 48 FEMALE
38 VOCAL ELVIE PAÑA 06/02/1983 37 FEMALE
39 ALO MANELYN DUMANDAN 03/02/1990 30 FEMALE
40 BOOC HAPPY KAY GUIBERNAS 08/28/1992 28 FEMALE
41 CABALLERO RUELITO CODINO 01/05/1968 52 MALE
42 CANALES IVY LAGAMON 08/19/1995 25 FEMALE
43 CARO NESTOR SAMZA 04/21/1980 40 MALE
44 CHAN CHARITO PLOYA 01/05/1976 44 FEMALE
45 ESCARTIN JOEY POLISTICO 01/22/1985 35 MALE
46 FALSIS AILEEN JEAN QUILOS 11/23/1972 47 FEMALE
47 GALLAWAN JUVY AGUILAR 09/11/1970 50 FEMALE
48 LASCUÑA EMILEE PALABRICA 01/12/1982 38 FEMALE
49 MALOT GENY TOLEDO 04/20/1964 56 FEMALE
50 MALUPA ROSEMARIE CARREON 06/23/1981 39 FEMALE
51 MANATAS MERCEDITA M. 02/27/1970 50 FEMALE
52 MINGOY CARMELITA ROMERA 12/28/1956 63 FEMALE
53 NACARIO FLORENCIO R. 07/18/1963 57 MALE
54 RATONEL NELSI GRIPON 08/27/1977 43 FEMALE
55 SEMILLA JOEY DELA PEÑA 07/21/1988 32 MALE
56 VILLAS ADONES NOBLE 04/27/1981 39 MALE
BAWAL BURAHIN ITO
Key Codes / Shortcuts
Male M
Female F
STATUS
Married MAR
Single SIN
Common Law CL
ERATIVE- MINTAL BRANCH AND CALINAN BUSINESS CENTER
Status BRANCH Plan Option Effectivity Date POLICY NO. HIB
MARRIED MINTAL WARD 8/10/2020 NEW 500

MARRIED MINTAL WARD 8/3/2020 NEW
SINGLE MINTAL WARD 8/15/2020 NEW
SINGLE MINTAL WARD 8/29/2020 RENEW
MARRIED MINTAL WARD 8/29/2020 RENEW
SEPARATED MINTAL WARD 8/29/2020 RENEW
MARRIED CALINAN WARD 8/7/2020 NEW
MARRIED CALINAN WARD 8/29/2020 RENEW
SINGLE CALINAN WARD 8/29/2020 RENEW
SINGLE CALINAN WARD 8/29/2020 RENEW
SEPARATED CALINAN WARD 8/29/2020 RENEW
1000
ADJUSTMENT/S
FICCO
CHMF
HIN ITO…..
Premium
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00 REPLACEMENT OF BANAGUA,CAROLYN DUE TO EXISTING HEALTHCARE. EMAILED ENROLLMENT LAST 8/5
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
2,700.00
PHP 151,200.00
PHP 15,120.00
PHP 100.00
PHP 15,020.00
PHP 137,180.00
MAILED ENROLLMENT LAST 8/5/2020.

Cooperative Health Management Federation Declaration Form AUGUST 2020 List of Enrollees Cooperative Name

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Cooperative Health Management Federation Declaration Form AUGUST 2020 List of Enrollees Cooperative Name

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Copyright:

Available Formats

COOPERATIVE HEALTH MANAGEMENT FEDERATION

Declaration Form AUGUST 2020

NOTE: PLEASE USE ALLCAPS WHEN INPUTTING THE ASSURED DETAILS

Name of Insured BirthDate

Status BRANCH Plan Option Effectivity Date POLICY NO. HIB

MARRIED MINTAL WARD 8/10/2020 NEW 500

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