’ maneyennss riety rLPPONE HEALTH INSURANCE CORPORATION imployer No.: CCitystate Centre 709 Shaw Boulevard, Pasig City ER1 EMPLOYER DATA RECORD 1. Name of Ageney/Office/Department (or Gov. Sexton /Business/Firm/ Employer (or private Sector) CompASIA Computer Repair Services Inc. TIN 186-080-564 2. Address of Agency Office! Depastment/ Busines, ler GSS isn Wackcthack Royal Wanslon: (Nc WER Greenhills, Mandaluyong Cty 28,,Tel, No, +83 2 8687 7900 3. EMail Address oo, porate, matters@lawphil.ph Postal 3: Postal Code 4. 1f Regional/Branch Office, State the 4a, MainHead Office/Employer name and address of Main/Head Office Onan i 4c. No. of Employees 2 5. Services Rendered/Nature of Business/Operation (for Private Sector) 6.Type of Agency (For Gov't Sector) Local Corporation National 1 constitutional (For Private Business/Operation) Single Proprietor [—] Partnership DX) ‘Computer repair and wholesale and retail of computer and computer parts Special Project Corporation Phen sgn cet teeta SHENNAN A. SY Date Head of Ageney or Representative Signature PRESIDENT Title or Position This portion is to be filled-up by PhilHealth Date Received: Evaluated by: Date Evaluation: Name and Signature PAE aeae TEs iy: