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    Membership Information Sheet: Paseguruhan NG Mga Naglilingkod Sa Pamahalaan Government Service Insurance System

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    Bonie Jay Mateo Dacot
    This document is a membership information sheet for the Government Service Insurance System (GSIS), a state-owned life insurance corporation that provides insurance coverage for Filipino government employees. It collects personal data like name, sex, civil status, date and place of birth, employment data such as office, date of original appointment, office address, position title, and salary information. The form is signed by the member and attested by a personnel or administrative officer.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Membership Information Sheet: Paseguruhan NG Mga Naglilingkod Sa Pamahalaan Government Service Insurance System

    Uploaded by

    Bonie Jay Mateo Dacot
    70 views1 page
    This document is a membership information sheet for the Government Service Insurance System (GSIS), a state-owned life insurance corporation that provides insurance coverage for Filipino government employees. It collects personal data like name, sex, civil status, date and place of birth, employment data such as office, date of original appointment, office address, position title, and salary information. The form is signed by the member and attested by a personnel or administrative officer.

    Original Description:

    FOR REFERENCE PURPOSES

    Original Title

    gsisMIS0301

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    This document is a membership information sheet for the Government Service Insurance System (GSIS), a state-owned life insurance corporation that provides insurance coverage for Filipino government employees. It collects personal data like name, sex, civil status, date and place of birth, employment data such as office, date of original appointment, office address, position title, and salary information. The form is signed by the member and attested by a personnel or administrative officer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views1 page

    Membership Information Sheet: Paseguruhan NG Mga Naglilingkod Sa Pamahalaan Government Service Insurance System

    Uploaded by

    Bonie Jay Mateo Dacot
    This document is a membership information sheet for the Government Service Insurance System (GSIS), a state-owned life insurance corporation that provides insurance coverage for Filipino government employees. It collects personal data like name, sex, civil status, date and place of birth, employment data such as office, date of original appointment, office address, position title, and salary information. The form is signed by the member and attested by a personnel or administrative officer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Form No.

    MIS-03-01

    PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN


    Government Service Insurance System
    Financial Center, Roxas Boulevard, Pasay City

    Latest 1 x 1
    ID Picture
    (within the
    MEMBERSHIP INFORMATION SHEET last three
    months)

    PERSONAL DATA:
    Name: ______________________________________________________________________________
    Last Name First Name Middle Name
    Sex: __________ Civil Status: ______________________ TIN: _______________________________

    Date of Birth: _____________________ Place of Birth:_____________________________________


    (Month/Day/Year) Town/District City/Province
    Residence/Mailing Address:
    ___________________________________________________________________________________
    No. Street Town/District City/Province Zip Code
    EMPLOYMENT DATA:
    Office: _______________________________ Date of Original Appointment: ____________________
    (Month/Day/Year)
    Office Address: ______________________________________________________________________
    No. Street Town/District City/Province
    Position Title: __________________________ Status of Appointment: __________________________

    Present Salary: _______________ Date of Effectivity of Present Salary: ________________________


    (Month/Day/Year)
    For DEPED Employees only: Division No.: ______ Station No.: _______ Employee No. ___________

    ____________________________
    Signature of Member

    Attested:

    ___________________________
    Signature over Printed Name of
    Personnel/Administrative Officer

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