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) : 16-025227553-0 PhilSys Number :
Member Category : INDIGENT - NHTS-PR
Sub-Category NHTS Coverage : EXISTING
Validity Period : 01/01/2016 - 12/31/2016

MARIBAO, MICHAEL DEGAMO

CANDALID TUBO-TUBO (NEW DEL MONTE), MONKAYO DAVAO DE ORO

Foreign Address : N/A Sex : MALE

Date of Birth : 01/01/1978
Place of Birth : MONKAYO, DAVAO DE ORO
Contact No. (Foreign) : N/A Civil Status : MARRIED
(Local) : N/A Tax Identification Number :

ENTITY INFORMATION
PhilHealth Number (PEN/POGN) : 400060003707
Name of Employer/Organized Group : DEPARTMENT OF HEALTH
hidden text
Business Address : SAN LAZARO COMPOUND RIZAL AVENUE, BGY 331, SANTA CRUZ NCR, CITY OF
hidden text MANILA, FIRST DISTRICT

Telephone Number : 632 6517800 Employment Status :

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

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
162519516381 MARIBAO BIENVINIDA AGUSTIN FEMALE SPOUSE 07/03/1982

162519516403 MARIBAO CHRISSHA MICHAELA AGUSTIN FEMALE CHILD 08/01/2010

*** NOTHING FOLLOWS ***

ATTY. HARVEY L. CARCEDO

REGIONAL VICE PRESIDENT
PRO - XI Davao 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.
Nov 09, 2022 07:12 PM