Republic of the Philippines

SOCIAL SECURITY SYSTEM 34-9808250-1

PERSONAL RECORD

Basic Information

Name of Applicant: AQUINO, ROSALIE BERTOLDO

Date of Birth: 04/14/2000 (mm/dd/yyyy)

Sex: FEMALE

Marital Status: SINGLE

Nationality: FILIPINO

Religion: CHRISTIAN

Place of Birth: CITY OF DASMARIÑAS CAVITE PHILIPPINES

Home Address: BLK 16 LOT 20 ANGELES ST. CITYHOMES SAMPALOC IV CITY OF DASMARIÑAS CAVITE 4114

Telephone No: 046-5317381

Mobile No: (0995) 234-0836

Email Address: rosalieakino20@gmail.com

Name of Father: AQUINO, RAMIL VILLANUEVA

Name of Mother: BERTOLDO, HEIDE MAGBANUA

Beneficiary(ies)

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