Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre Building, 709 Shaw Boulevard, Pasig City
Healthline: 441-7444 Website: www.philhealth.gov.ph

STATEMENT OF PREMIUM ACCOUNT (SPA) - FORMAL SECTOR

PEN : 001000034888 SPA No. : SPA100007286390

Employer Type : Private Date Generated : Oct 26, 2016
Business/Agency Name : DBMC CORPORATION
Premium Due Date:
Group Account Name: Please Pay Immediately

CURRENT CHARGES:
Applicable Month : August 2016
No. of Employees : 17
Amount of Premium:
Employee Share 3,725.00
Employer Share 3,725.00
Premium Due for the Current Applicable Period 7,450.00
TOTAL AMOUNT DUE 7,450.00

IMPORTANT REMINDER:
Per available records, it appears that you may have missed paying and/or reporting your payments for the following applicable
period/s:
SPA Number Applicable Month/s Premium/Report Due
SPA100007274645 Feb 2016 5,900.00
SPA100007274644 Apr 2016 8,010.83
SPA100007261151 May 2016 5,900.00
SPA100007261154 Jun 2016 5,900.00
SPA100007261155 Jul 2016 5,900.00
Sep 2016

Please settle the above accounts immediately and coordinate with your PAIMS (or visit the nearest PhilHealth Office) to assist
you in posting these payments. Thank you.

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PHILHEALTH EPRS PREMIUM PAYMENT SLIP

Remittance Due Date : Please Pay Immediately SPA No. : SPA100007286390
Date Generated : Oct 26, 2016
PEN : 001000034888 Employer Type : Private
Business/Agency Name : DBMC CORPORATION
Applicable Month : August 2016 No. of Employees : 17

Principal Grouping No:

Principal Name:

Amount of Premium:
Employee Share 3,725.00
Employer Share 3,725.00
Premium Due for the Current Applicable Period 7,450.00
TOTAL AMOUNT DUE 7,450.00