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    Gip Gsis Form

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    Christian Paul Gecana Gonzales
    This document is an enrollment form for group personal accident insurance through the Government Service Insurance System. It lists 32 individuals enrolled in the insurance program. For each person, it provides their name, address, date of birth, age, barangay, city, province, and designated beneficiary. The coverage period is from January 2023 to January 2024.

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

    Gip Gsis Form

    Uploaded by

    Christian Paul Gecana Gonzales
    40 views2 pages
    This document is an enrollment form for group personal accident insurance through the Government Service Insurance System. It lists 32 individuals enrolled in the insurance program. For each person, it provides their name, address, date of birth, age, barangay, city, province, and designated beneficiary. The coverage period is from January 2023 to January 2024.

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    This document is an enrollment form for group personal accident insurance through the Government Service Insurance System. It lists 32 individuals enrolled in the insurance program. For each person, it provides their name, address, date of birth, age, barangay, city, province, and designated beneficiary. The coverage period is from January 2023 to January 2024.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    40 views2 pages

    Gip Gsis Form

    Uploaded by

    Christian Paul Gecana Gonzales
    This document is an enrollment form for group personal accident insurance through the Government Service Insurance System. It lists 32 individuals enrolled in the insurance program. For each person, it provides their name, address, date of birth, age, barangay, city, province, and designated beneficiary. The coverage period is from January 2023 to January 2024.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 2

    ANNEX A

    ENROLLMENT FORM TO GROUP PERSONAL ACCIDENT INSURANCE


    OF THE GOVERNMENT SERVICE INSURANCE SYSTEM

    REPUBLIC OF THE PHILIPPINES


    DEPARTMENT OF LABOR AND EMPLOYMENT
    Employment Programs of DOLE (SPES/GIP/DILEEP)

    DOLE's Program : GOVERNMENT INTERNSHIP PROGRAM


    Name of Employer : DEPARTMENT OF LABOR & EMPLOYMENT REGION IV-A
    Address : 3rd & 4th Floor Andenson Bldg. II, Brgy. Parian, Calamba City
    Name of Assured :
    Address :
    Period of Coverage : JANUARY 2023 - JANUARY 2024
    Name of Insured* Address
    No. Surname First Name Middle Initial/Name Extension Name Date of Birth Age Brgy. City/Municipality Province District Beneficiary
    1 LAGMAN JOHN VINCENT JEREMIAH RUBIO 6/4/1999 23 DILA SANTA ROSA CITY LAGUNA 1 ROSAIDA LAGMAN

    2 BARTOLAZO EMMANUEL BASCO 12/20/2001 21 SINALHAN SANTA ROSA CITY LAGUNA 1 ROSEMELINDA BARTOLAZO

    3 FLORIDA KHEYSEL MAE RICAMARA 9/9/1999 23 DILA SANTA ROSA CITY LAGUNA 1 MILDRED FLORIDA

    4 TAPANGCO LOVELY MASUSI 7/20/2002 20 SINALHAN SANTA ROSA CITY LAGUNA 1 HERMINIA TAPANCGO

    5 GETAPE DON ALBERT SABILE 4/18/1994 28 DILA SANTA ROSA CITY LAGUNA 1 REI MATTHEW GETAPE

    6 ARCEO IVY ROSE COMPLETO 1/25/2000 22 MACABLING SANTA ROSA CITY LAGUNA 1 LIZA ARCEO

    7 ROSALES JOHN CHRISTIAN COMETA 12/25/1999 23 CAINGIN SANTA ROSA CITY LAGUNA 1 JENNIFER ROSALES

    8 SALVATIERRA JOSE MARI PARUNGAO 5/23/1999 23 TAGAPO SANTA ROSA CITY LAGUNA 1 DOLORES SALVATIERRA

    9 ALIBUDBUD GRYSHIELD PARAYAN 10/31/1992 30 APLAYA SANTA ROSA CITY LAGUNA 1 MARWIN S. ALIBUDBUD

    10 ALOMIA CARLO TORRES 5/11/1996 26 APLAYA SANTA ROSA CITY LAGUNA 1 CAMILLE S. ALOMIA

    11 BAYANGAT WENDELYN CADACIO 10/15/1993 29 IBABA SANTA ROSA CITY LAGUNA 1 MARIVIC C. BAYANGAT

    12 LAZO CHRISTOPHER ALLEN FACTORIZA 11/15/2001 21 APLAYA SANTA ROSA CITY LAGUNA 1 CRISPIN B. LAZO

    13 BRADECENA ALLYSA MAY - 11/14/1998 25 LABAS SANTA ROSA CITY LAGUNA 1 ALBERTO DAWINAN JR

    14 BARRETTO KRISTELE MAE LEYSON 10/23/2002 21 SINALHAN SANTA ROSA CITY LAGUNA 1 ANGELITO C. BARRETTO

    15 AMARANTE SHAWN ETHAN BAYANI 1/18/2003 20 BALIBAGO SANTA ROSA CITY LAGUNA 1 SHIELA B. AMARANTE

    16 CANILLO PAULINE ALMODOVAR 10/23/1999 23 APLAYA SANTA ROSA CITY LAGUNA 1 VIOLETA A. CANILLO

    17 BRECIO CHRISTIAN PADERON 12/1/2001 22 POOC SANTA ROSA CITY LAGUNA 1 LORENA P. BRECIO

    18 MITRA RICHARD MARK INAWAS 6/8/1996 26 CAINGIN SANTA ROSA CITY LAGUNA 1 RODRIGO MITRA JR.

    19 REMIGIO LARRA JANE ANORE 12/20/1996 26 SINALHAN SANTA ROSA CITY LAGUNA 1 RENATO G. REMIGIO

    20 URDANETA MA. ALEXIA RAC 3/11/2000 22 APLAYA SANTA ROSA CITY LAGUNA 1 JERUME F. URDANETA

    21 ALCARAZ RHAEL GRUCIO 8/19/1995 25 DITA SANTA ROSA CITY LAGUNA 1 BIANCA R. ALCARAZ

    22 BEATO RESALYN UMALI 11/9/1998 25 SINALHAN SANTA ROSA CITY LAGUNA 1 FROILAN E. ELOMINA

    23 ALMODOVAR GERMIN RAE LAUREL 2/9/1994 28 MARKET AREA SANTA ROSA CITY LAGUNA 1 GERONIMA L ALMODOVAR

    24 BASARAN MARK JEROME RAMOS 5/18/1994 28 CAINGIN SANTA ROSA CITY LAGUNA 1 LOLITA BASARAN
    25 DUGAY SAMUEL EHROLE TALIBSAO 8/13/2000 22 CAINGIN SANTA ROSA CITY LAGUNA 1 SHELA T. DUGAY

    26 BARTOLAZO VEEJAY CALAUAGAN 10/31/1998 25 SINALHAN SANTA ROSA CITY LAGUNA 1 FLAVIANO B. BARTOLAZO

    27 BARDOQUILLO KYLE DOMINIC CRUZ 9/26/1995 27 DILA SANTA ROSA CITY LAGUNA 1 EVELYN C. BARDOQUIILLO

    28 ALCERA KEIN BRIXX ABION 10/3/1999 24 DILA SANTA ROSA CITY LAGUNA 1 MYRA A. ALCERA

    29 CORREA ALLAINE EMPERADOR 2/6/1997 26 MALUSAK SANTA ROSA CITY LAGUNA 1 STEPHEN CHARLES IMMANUEL EMPERADOR

    30 ALIWATE STEPHEN MITZ FLORES 3/28/1999 22 DILA SANTA ROSA CITY LAGUNA 1 MEAH F. ALIWATE

    31 MAMERTO SHANE GARALDE 1/2/2003 20 SINALHAN SANTA ROSA CITY LAGUNA 1 ALVIN MAMERTO

    32 DIMAANO ICY GERAMAE BANTA 3/5/1997 28 CAINGIN SANTA ROSA CITY LAGUNA 1 ISABEL B. DIMAANO

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