Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Corporate Action Center Hotline - (02) 441-7442
www.philhealth.gov.ph

MEMBER DATA RECORD

MEMBER BASIC INFORMATION
PhilHealth Identification Number (PIN) : 11-025078023-0 PhilSys Number :
Member Category : DIRECT CONTRIBUTOR -
Sub-Category EMPLOYED PRIVATE NHTS Coverage : N/A
Validity Period : N/A - N/A

DEQUIÑA, REYMUND DELA

3 CARAWISAN II, SAN REMIGIO ANTIQUE

Foreign Address : N/A Sex : MALE

Date of Birth : 05/29/1982
Place of Birth : PANITAN, CAPIZ
Contact No. (Foreign) : N/A Civil Status : MARRIED
(Local) : 5435767 Tax Identification Number :

ENTITY INFORMATION
PhilHealth Number (PEN/POGN) : 011030000133
Name of Employer/Organized Group : GATEWAY 21-25 CONSTRUCTION CORPORATION
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Business Address : FENETE ST, DISTRICT III (POB.), SIBALOM ANTIQUE
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Telephone Number : Employment Status : EMPLOYED
Tax Identification Number : 178869101 Date :

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
112503877174 DEQUIÑA MERREY ANGELIE MISSION FEMALE DAUGHTER 01/02/2009

112503877166 DEQUIÑA MERELLE MISSION FEMALE WIFE 01/22/1980

112543443541 DEQUIÑA PRECIOUS ALLYSIAH MISSION FEMALE DAUGHTER 10/17/2012

*** NOTHING FOLLOWS ***

JANET A. MONTEVERDE
ACTING REGIONAL VICE PRESIDENT
PRO - VI Iloilo City

Paalala: Basahin ang nilalaman ng MDR. Kung may kulang o mali, ibalik agad upang 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 MDR and do not hand it over to anybody. Provide photocopy to hospital in case of confinement and
availment of benefits.)
This is a Member Portal System generated report. Signature is not required.
Jan 16, 2023 08:46 AM