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) : 120250942627
Member Category : FORMAL ECONOMY NHTS Coverage :
Sub-Category : GOVERNMENT Effectivity Period :

BELLIOT , JENNETTE GADIS

PRK 1B MARCELO ST POBLACION, LINGIG,
SURIGAO DEL SUR 8312

Foreign Address : N/A Sex : Female

Date of Birth : 06/03/1978
Place of Birth : BISLIG CITY, SURIGAO DEL SUR

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

(Local) : Tax Identification Number :

EMPLOYER/ORGANIZED GROUP INFORMATION

PhilHealth Number (PEN/POGN) : 141268000002
Name of Employer/Organized Group : LINGIG NATIONAL HIGH SCHOOL
Business Address : PRK 2B SOUVENIR ST POBLACION, LINGIG, SURIGAO DEL SUR

Telephone Number : N/A

Tax Identification Number : 000556934

DEPENDENT INFORMATION
PIN Surname Given Name Middle Name Sex Relation Date of Birth
122509150441 BELLIOT YENNY BLAND GADIS Female Daughter 3/16/2008
BELLIOT ELIANA MARIE GADIS Female Daughter 12/22/2011
122509150433 BELLIOT REX V Male Husband 5/21/1965
122509150425 BELLIOT ZERUBBABEL BENREX G Male Son 1/28/2005
*** NOTHING FOLLOWS ***

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.

2/7/2018 9:36:53 AM