‘CLAIM WO, Republic of he Philpplnes SOCIAL SECURITY SYSTEM SICKNESS NOTIFICATION RE-FILING CLAM NO.. Ceo sea Hel yaed iti ty tf genaiyn Gvanue a He Alcon” Beanie “PUR? AGP ia by RLERRONE NO weerzorsraer ROBTECELLFRONE ao one lasy siarp- lord sy [osc Bias] grdarenrreuy 04/0 ginal com RE CERES ram ure Po Tear na Canaan 0 recy td ‘clon ar the wineeses to taerrintn saat ‘member ant fe geri. Pease reed intucon Wo.6e he fm. | em ee ee ee TR COTTER TARTI-TOBE FLLED OUT BY EUPLOVER [EPC RE AE OF ERPS TERRES TERED BISTEES NATE] EW RESET hi eet ISTE ROORESS FEF a ar re ARTF STERE —ORETTONTORTITS iii dyit rm Eines Prema Jonni i [Bon sti ca snow Clune Suzenion PART It MEDIGAL CERTIFICATE! {BE FLED OUT BY THE ATTENONG PVSIOAN) FEF MEDOAC STORY ANO PERTINENT FROGS fed o Ly, Arky Reber ee eg 1 catty tat have seen ang exam T coy thal the above Woman a Ws sod covet and thatthe Fopoad BasGarTnace © Gay eoonea he Employrs Logbook or EC Gaim under page numer and ey ruber, GEFCACESTENATION sbove-narad patent on JUL-/- 247, 262° and in my opinion, caninement ‘ecu reciprton pores may at — JO dye. fall. 10,26) Wa So Za ACKNOWLEDGEMENT STUB. Reece aor oe re Lactate Jititirs ae