Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Corporate Action Center Hotline - (02)441-7442
MDR
www.philhealth.gov.ph

MEMBER DATA RECORD

MEMBER INFORMATION
Philhealth Identification Number (PIN) : 022521630071
Member Category : INFORMAL ECONOMY NHTS Coverage :
Sub-Category : SELF-EARNING INDIVIDUAL Effectivity Period :

GILA , CRISANTO MANUEL

BLOCK4 LOT7 1991 PHASE 3 B BGY 174,
CALOOCAN CITY, THIRD DIST. 1400

Foreign Address : N/A Sex : Male

Date of Birth : 07/17/1989
Place of Birth : CALOOCAN CITY, THIRD DIST.

Contact No.(Foreign) : N/A Civil Status : MARRIED

(Local) : Tax Identification Number :

EMPLOYER/ORGANIZED GROUP INFORMATION

PhilHealth Number (PEN/POGN) : N/A
Name of Employer/Organized Group : N/A
Business Address : N/A

Telephone Number : N/A

Tax Identification Number : N/A

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
*** NO DECLARED DEPENDENT/S ***

Paalala: Basahin ang nilalaman ng MDR. Kung may kulang o mali, dalhin agad ang kopya sa pinakamalapit na PhilHealth Office upang maiwasto. Ingatan ang inyong kopya ng MDR
at huwag ibigay kahit kanino.
Reminder: Read the contents of the MDR. Should there be discrepancies, bring your copy to the nearest PhilHealth Office to amend or rectify error. Take good care of the MDR
and do not hand it over to anybody.

This is a Member Inquiry System generated report.

8/16/2019 10:50:35 AM