Republic of the Philippines

SOCIAL SECURITY SYSTEM 34-9121292-5

PERSONAL RECORD

Basic Information

Name of Applicant: LASCIERAS, LECHAR FRANCE VELASCO

Date of Birth: 01/16/2001 (mm/dd/yyyy)

Sex: MALE

Marital Status: SINGLE

Nationality: FILIPINO

Religion: CHRISTIAN

Place of Birth: QUEZON CITY METRO MANILA PHILIPPINES

Home Address: BLOCK 1 LOT 27 KATARUNGAN EXTENSION ST FRANCIS SAN AGUSTIN QUEZON CITY METRO MANILA 1117

Telephone No:

Mobile No: (0956) 842-4488

Email Address: iskowwww@gmail.com

Name of Father: LASCIERAS, RICHARD MANALO

Name of Mother: VELASCO, LETY PATUBO

Beneficiary(ies)

Purpose of Application

Purpose: FOR EMPLOYMENT

Applicant's Certification

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Signature Over Printed Name Date LEFT THUMB MARK RIGHT THUMB MARK

TO BE FILLED OUT BY SSS

EVALUATED BY:

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Signature Over Printed Name Date Time Branch