Republic of the Philippines (090504476668)

PHILIPPINE HEALTH INSURANCE CORPORATION

XENTROMALL BATANGAS CITY, DIVERSION ROAD, BRGY. ALANGILAN, BATANGAS CITY
(043) 723 8822 loc. 201 (043) 723 8820
www.philhealth.gov.ph

MEMBER DATA RECORD

MEMBER BASIC
PhilHealth Identification Number (PIN) : 090504476668 PhilSys Number : :
Member Category : INDIRECT CONTRIBUTOR - POINT
Sub-Category : OF SERVICE (POS) FINANCIALLY NHTS Coverage : N/A
INCAPABLE Validity Period : 1/1/2022 - 12/31/2022

SILVA, MA ANGELA OPIASA

BUBOG, SAN JOSE, OCCIDENTAL MINDORO - 5100

Foreign Address : N/A Sex : FEMALE

Date of Birth : 11/3/1995
Place of Birth : CALATAGAN, BATANGAS
Contact No. (Foreign) : N/A Civil Status : MARRIED
(Local) : / Tax Identification Number :
ENITY INFORMATION

Philhealth Number (PEN/POGN) : 012000038246

Name of Employer/Organized Group : N/A

Business Address : N/A

Telephone Number : N/A Employment Status : N/A

Tax Identification Number : N/A Date : N/A

DEPENDENT
PIN Surname Given Name Middle Name Sex Relation Date of Birth

092532120189 SILVA JOHNELLAH KHARYLL OPIASA Female Daughter 12/22/2012

092546910328 SARMIENTO KAZZANDRA OPIASA Female Daughter 3/17/2020

*** NOTHING FOLLOWS ***

ATTY. JERRY F. IBAY

REGIONAL VICE PRESIDENT
PRO IV-B Batangas City

Paalala : Basahin ang nilalaman ng MDR. Kung may kulang o mali, ibalik agad upang maidagdag o maiwasto. Ingatan ang orihinal na
kopya at huwag ibigay kahit kanino. Kung sakaling gagamit at makikinabang ng benepisyo, magbigay ng kopya sa ospital.
(Reminder: Read the
contents of the MDR. Should there be any data discrepancies, return it back to amend or rectify the error. Take good care of the MDR and do not hand it over to anybody.
Provide photocopy to hospital in case of confinement and availment of benefits.)

This is a system generated report. Signature is not required. Printed At : Occidental Service Office - ANTRAM Building, Seabreeze Subd., Tayamaan, Mamburao,
10/18/2022 11:08:19 AM
20449304 20449304 5/15/2015 / 20449304 10/18/2022 Occidental Mindoro