NATIONAL HEALTH INSURANCE CORPORATION REPUBLIC OF KOREA

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

[hwp/doc/pdf]NATIONAL HEALTH INSURANCE CORPORATION REPUBLIC OF KOREA