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    Affidavit of Income Philhealth

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    John Jeric Lim
    Edgardo N. Gurre declares in an affidavit that he is retired and relies on his wife's income as a seafarer for financial support of their family. He states that he is a bona fide member of PhilHealth with a specific PIN number. The purpose of the affidavit is to comply with PhilHealth requirements to determine the applicable premium bracket for his coverage.

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    Affidavit of Income Philhealth

    Uploaded by

    John Jeric Lim
    289 views1 page
    Edgardo N. Gurre declares in an affidavit that he is retired and relies on his wife's income as a seafarer for financial support of their family. He states that he is a bona fide member of PhilHealth with a specific PIN number. The purpose of the affidavit is to comply with PhilHealth requirements to determine the applicable premium bracket for his coverage.

    Original Title

    AFFIDAVIT OF INCOME PHILHEALTH

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    Edgardo N. Gurre declares in an affidavit that he is retired and relies on his wife's income as a seafarer for financial support of their family. He states that he is a bona fide member of PhilHealth with a specific PIN number. The purpose of the affidavit is to comply with PhilHealth requirements to determine the applicable premium bracket for his coverage.

    Copyright:

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

    Affidavit of Income Philhealth

    Uploaded by

    John Jeric Lim
    Edgardo N. Gurre declares in an affidavit that he is retired and relies on his wife's income as a seafarer for financial support of their family. He states that he is a bona fide member of PhilHealth with a specific PIN number. The purpose of the affidavit is to comply with PhilHealth requirements to determine the applicable premium bracket for his coverage.

    Copyright:

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

    REPUBLIC OF THE PHILIPPINES)

    CITY OF TAGBILARAN )S.S.


    X- - - - - - - - - - - - - /

    AFFIDAVIT OF INCOME DECLARATION

    I, EDGARDO N. GURRE, Filipino, of legal age, married, and a resident of


    Manga, Tagbilaran City, Bohol, Philippines, after having sworn in accordance with law,
    depose and say that:

    1. I am a bona fide PhilHealth member with PIN: 19-026365326-6;

    2. I have not been gainfully employed as I am a retired mechanical engineer and I


    have only relied on my wife for financial support who receives income as a
    seafarer;

    3. The whole family depends on the monthly income of my wife for support;

    4. I am executing this Affidavit-Declaration to comply with the PhilHealth


    requirement in the determination of the applicable premium bracket to be
    imposed by them and for all legal purposes this may serve.

    IN WITNESS WHEREOF, I have hereunto set my hand this 14 th day of January


    2020 in the City of Tagbilaran, Province of Bohol, Philippines.

    EDGARDO N. GURRE
    Affiant-Declarant
    PhilHealth No. 19-026365326-6
    Issued by: PhilHealth

    SUBSCRIBED AND SWORN TO BEFORE ME, this 14 th day of January, 2020, in the
    City of Tagbilaran, Province of Bohol, Philippines.

    Doc. No. 29;


    Page No. 4;
    Book No. 1;
    Series of 2020.
    ATTY. JOHN JERIC S. LIM
    NOTARY PUBLIC COMM UNTIL DEC. 31, 2021
    Attorney’s Roll No. 70690
    IBP No. 095579 for 2020
    PTR No. 7940547 for 2020
    TIN No. 278608672
    NCS No. 2020-21

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