NATIONAL HEALTH INSURANCE CORPORATION REPUBLIC OF KOREA
168-9, Yeumri-dong, Mapo-gu, Seoul, KOREA.(121-749)/Tel( )- /Fax( )-
Manager : Assistant Manager : Deputy :
CERTIFICATE OF THE INSURED
NO. OF ISSUE :
□ HOUSEHOLDER
□ INSURED
PERSON
NO. OF
Health INSURANCE CARD
ORGANIZA-
TION CODE
NAME IN
FULL
RESIDENT REG. NO.
DATE OF
QUALIFI-
CATION
DATE OF
DISQUALIF-ICATION
□ INSURED
PERSONS
□ DEPENDENTS
NAME IN
FULL
RESIDENT REG. NO.
DATE OF
QUALIFI-
CATION
DATE OF
DISQUALIFI-CATION
NOTE
This is to certify the above he or she'sa beneficiary under the provision of Article 5 of National Health Insurance Act in Korea.(But, insurance benefits shall be suspended during the period he or she is on a trip or working abroad.)
DATE OF ISSUE :
DIRECTOR
REGIONAL OFFICE
NATIONAL HEALTH INSURANCE CORPORATION REPUBLIC OF KOREA |
2007.11.28
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