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's a 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