Republic of the Philippines
SOCIAL SECURITY SYSTEM
PERSONAL RECORD
34-7232280-5
Basic Information
Name of Applicant:GAZZINGAN, SHANE RICHEL MANIAGO
Date of Birth:01/24/1999 (mm/dd/yyyy)
Gender:FEMALE
Marital Status:SINGLE
Nationality:FILIPINO
Religion:ROMAN CATHOLIC
Place of Birth:SANTA MARIA ISABELA PHILIPPINES
Home Address:1503 SAMPAGUITA ST MALARIA TALA CALOOCAN CITY BARANGAY 185 CALOOCAN CITY METRO MANILA1427
Telephone No:
Mobile No:(0921) 282-1555
Email Address:[email protected]
Name of Father:GAZZINGAN, RICHARD MALSI
Name of Mother:MANIAGO, MARICEL GASATAN
Beneficiary(ies)
Purpose of Application
Purpose:FOR EMPLOYMENT
Applicant’s Certification
____________________________________Signature Over Printed Name
__________________ Date
LEFT THUMB MARK
RIGHT THUMB MARK
TO BE FILLED OUT BY SSS
EVALUATED BY: ___________________________________ ______________________ ______________________ ______________________ Signature Over Printed Name Date Time Branch
