Republic of the Philippines

SOCIAL SECURITY SYSTEM 34-7785961-6

PERSONAL RECORD

Basic Information

Name of Applicant: RAPOTE, CHRISTIAN PEREZ

Date of Birth: 10/15/1996 (mm/dd/yyyy)

Sex: MALE

Marital Status: SINGLE

Nationality: FILIPIN

Religion: Place O

of Birth: ROMAN CATHOLIC

Home Address: BAYAMBANG PANGASINAN PHILIPPINES

Telephone No: SANTA MONICA SANTA RITA PAMPANGA 2002

Mobile No:

Email Address: (0950) 051-4008

Name of Father: christian.rapote1996@outlook.com RAPOTE,

Name of Mother: EUFEMIO JR GARCIA PEREZ,

VERONICA CARCAMO
Beneficiary(ies)

Other Beneficiary/ies: RAPOTE, EUFEMIO JR GARCIA (Guardian/Caretaker)

PEREZ, VERONICA CARCAMO (Guardian/Caretaker)

Purpose of Application

Purpose: FOR EMPLOYMENT / PRIOR REGISTRANT

Estimated Monthly Salary:

Applicant's Certification

Signature Over Printed Name Date LEFT THUMB MARK RIGHT THUMB MARK

TO BE FILLED OUT BY SSS

EVALUATED BY:

Signature Over Printed Name Date Time Branch