Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Corporate Action Center Hotline - (02) 441-7442
www.philhealth.gov.ph
MDR
MEMBER DATA RECORD
MEMBER BASIC INFORMATION
PhilHealth Identification Number (PIN) : 01-026179697-5
: 13-251348715-4 PhilSys Number :
Member Category : DIRECT
: FORMAL CONTRIBUTOR
ECONOMY - -
Sub-Category EMPLOYED PRIVATE NHTS Coverage : N/A
FORMAL SECTOR
Validity Period : N/A - N/A

GOBATON, JOY DISTRAJO

JADULCO, AYAH CLAIRE ANN LOMENARIO
SAN ANTONIO BASEY SAMAR
1455 PALCON LA PURISIMA (LA PURISIMA AGUPIT), NABUA CAMARINES SUR

: FEMALE
Foreign Address : N/A Sex : FEMALE
Date of Birth ::09/21/1994
07/19/1998

Place of Birth ::BULA,

BASEYCAMARINES
WESTERN SAMAR
SUR
Contact No. (Foreign) : N/A Civil Status ::SINGLE
SINGLE
(Local) : 09276201525 Tax Identification Number ::

ENTITY INFORMATION
PhilHealth Number (PEN/POGN) : 200276307063
Name of Employer/Organized Group : NAVARRO AMPER & CO(MANABAT DELGADO AMPER & CO(C L MANABAT & COMPANY))
hidden text
Business Address : 19TH FLR SIX NEO BLDG 5TH AVE COR 26TH ST BONIFACIO GLOBAL CITY, FORT
hidden text BONIFACIO, TAGUIG CITY FOURTH DIST.

Telephone Number : 8120535 Employment Status : EMPLOYED

Tax Identification Number : 005299331 Date : 08/22/2017

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
*** NOTHING FOLLOWS ***

HENRY V. ALMANON
REGIONAL VICE PRESIDENT
Philhealth Regional Office - V Legaspi 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.
Sep 03, 2022 04:00 PM