BILLING

POLICYNO BP NO LASTNAME FIRSTNAME MI PFX DUEDATE PS GS

CM00006403 2E+09 ABING REGIDOR S Feb-13 2,883.96 3,845.28
CM00004660 2E+09 ADONACIONNORA L Feb-13 4,144.23 5,525.64
LP02003907 2E+09 AGUSTIN NOREEN L Feb-13 1,250.10 1,666.80
LP59112100 2E+09 ALATAN ENESA B Feb-13 3,966.75 5,289.00
CM00006401 2E+09 ALLER ARTHUR A Feb-13 3,966.75 5,289.00
CM00003390 2E+09 ARINDAENG CRISANTA G Feb-13 4,144.23 5,525.64
CM00004606 2E+09 ARSUA ARSENIO T Feb-13 1,548.81 2,065.08
LP60091600 2E+09 BALAYON LUCIA C Feb-13 3,880.89 5,174.52
CM00006401 2E+09 BANAIS ALBERT D Feb-13 1,287.99 1,717.32
LP02003936 2E+09 BUGHAO CHERYL ANY C Feb-13 1,162.89 1,550.52
LP02004090 2E+09 BUYCO JAN MICHAELA Feb-13 1,162.89 1,550.52
CM00006401 2E+09 CABRADILLAPEDRO D Feb-13 1,518.30 2,024.40
CM00004617 2E+09 CANARIA CARLITO N Feb-13 1,262.61 1,683.48
LP02003936 2E+09 DALIPE JILLDON G Feb-13 1,948.50 2,598.00
LP02003936 2E+09 ESCOBAR ROWENA M Feb-13 1,669.41 2,225.88
LP66071601 2E+09 GAYDA JULIUS O Feb-13 1,772.10 2,362.80
LP02003517 2E+09 GONZAGA MEDILYN S Feb-13 2,445.66 3,260.88
LP02004058 2E+09 LARUAN CONCHA U Feb-13 936.09 1,248.12
LP02003936 2E+09 LAVANIEGO VIRGILIO D Feb-13 945.45 1,260.60
CM00004616 2E+09 LUCAS ROMANA M Feb-13 4,054.50 5,406.00
LP59051902 2E+09 MALANA LESTER ROME Feb-13 0.00 0.00
CM00004602 2E+09 RONCAL EDEGARY H Feb-13 4,729.23 6,305.64
LP59090302 2E+09 SANADA ALMA T Feb-13 2,852.64 3,803.52
LP58122302 2E+09 SILVA DIANNE A Feb-13 5,220.54 6,960.72
LP79092501 2E+09 SOLANO IAN L Feb-13 1,686.15 2,248.20
CM00005009 2E+09 SOLIS HAZEL G Feb-13 1,686.15 2,248.20
CM00006400 2E+09 SUIB MOHAMMAD A K Feb-13 4,144.23 5,525.64
CM00006402 2E+09 SUMALPONGANDRE BONNM Feb-13 1,686.15 2,248.20
LP02003936 2E+09 TAMAYO JOEY B Feb-13 1,357.29 1,809.72
LP59051902 2E+09 MALANA LESTER ROME Jan-12 4,134.06 5,512.08
LP02003937 2E+09 MARCELINO BERNIE A Jan-12 0.00 0.00
LP59111500 2E+09 MISA MARILOU P Jan-12 2,616.12 3,488.16
CM00004606 2E+09 MUNOZ DIOSDADO B Jan-12 2,797.20 3,729.60
LP02003937 2E+09 PACETE HONIE LEI C Jan-12 0.00 0.00
LP62122400 2E+09 PENAMANTEJOY MARCELP Jan-12 2,547.45 3,396.60
CM00004615 2E+09 PEPITO VICTORIA C Jan-12 0.00 0.00
CM00003389 2E+09 PULA JUSTA J Jan-12 2,797.20 3,729.60
CM00004613 2E+09 RAMISO LEONORA H Jan-12 1,897.02 2,529.36
CM00006403 2E+09 RODA TERESITA P Jan-12 1,510.74 2,014.32
LP55100102 2E+09 SALANO ROMEO T Jan-12 0 0.00
LP58082100 2E+09 SALIGANAN MARILYN B Jan-12 2,651.22 3,534.96
LP02004031 2E+09 SAN JUAN RONNIE E Jan-12 1,159.20 1,545.60
CM00005009 2E+09 SOLIS HAZEL G Jan-12 1,538.91 2,051.88
CM00004621 2E+09 SUMAOANG ANGELITA J Jan-12 1,435.32 1,913.76
CM00004339 2E+09 UY PHEMIE T Jan-12 2,257.65 3,010.20
LP02003937 2E+09 VEGA GERALDINE G Jan-12 0.00 0.00
BILLING REMITTANCE TOTAL
EC PS GS EC BILLING REMITTANCE
100 2,883.96 3,845.28 100 6,829.24 6,829.24
100 4,144.23 5,525.64 100 9,769.87 9,769.87
100 1,250.10 1,666.80 100 3,016.90 3,016.90
100 3,966.75 5,289.00 100 9,355.75 9,355.75
100 3,966.75 5,289.00 100 9,355.75 9,355.75
100 4,144.23 5,525.64 100 9,769.87 9,769.87
100 1,548.81 2,065.08 100 3,713.89 3,713.89
100 3,880.89 5,174.52 100 9,155.41 9,155.41
100 1,287.99 1,717.32 100 3,105.31 3,105.31
100 1,162.89 1,550.52 100 2,813.41 2,813.41
100 1,162.89 1,550.52 100 2,813.41 2,813.41
100 1,518.30 2,024.40 100 3,642.70 3,642.70
100 1,262.61 1,683.48 100 3,046.09 3,046.09
100 1,948.50 2,598.00 100 4,646.50 4,646.50
100 1,669.41 2,225.88 100 3,995.29 3,995.29
100 1,772.10 2,362.80 100 4,234.90 4,234.90
100 2,445.66 3,260.88 100 5,806.54 5,806.54
100 936.09 1,248.12 100 2,284.21 2,284.21
100 945.45 1,260.60 100 2,306.05 2,306.05
100 4,054.50 5,406.00 100 9,560.50 9,560.50
0 4,729.23 6,305.64 100 0.00 11,134.87
100 4,729.23 6,305.64 100 11,134.87 11,134.87
100 2,852.64 3,803.52 100 6,756.16 6,756.16
100 5,220.54 6,960.72 100 12,281.26 12,281.26
100 1,686.15 2,248.20 100 4,034.35 4,034.35
100 1,686.15 2,248.20 100 4,034.35 4,034.35
100 4,144.23 5,525.64 100 9,769.87 9,769.87
100 1,686.15 2,248.20 100 4,034.35 4,034.35
100 1,357.29 1,809.72 100 3,267.01 3,267.01
100 4,134.06 5,512.08 100 9,746.14 9,746.14
0 866.52 1,155.36 96.28 0.00 2,118.16
100 2,616.12 3,488.16 100 6,204.28 6,204.28
100 0.00 0.00 0 6,626.80 0.00
0 1,244.97 1,659.96 100 0.00 3,004.93
100 2,547.45 3,396.60 100 6,044.05 6,044.05
0 1,897.02 2,529.36 100 0.00 4,526.38
100 2,797.20 3,729.60 100 6,626.80 6,626.80
100 1,897.02 2,529.36 100 4,526.38 4,526.38
100 1,510.74 2,014.32 100 3,625.06 3,625.06
0 1,337.13 1,782.84 100 0.00 3,219.97
100 2,651.22 3,534.96 100 6,286.18 6,286.18
100 1,159.20 1,545.60 100 2,804.80 2,804.80
100 0.00 0.00 0 3,690.79 0.00
100 1,435.32 1,913.76 100 3,449.08 3,449.08
100 2,257.65 3,010.20 100 5,367.85 5,367.85
0 1,079.28 1,439.04 100 0.00 2,618.32
RECONCILIATION BILLING ISSUES

Agency 1000002353
Broker Report
Run Date

BILLING
POLICYNO BP NO LASTNAME FIRSTNAME MI PFX DUEDATE PS
LP59051902194 2000198973 MALANA LESTER ROMEO E Feb-13 0
BILLING REMITTANCE VARIANCE
GS EC TOTAL PS GS EC TOTAL PS GS EC
0.00 0 0.00 4,729.23 6,305.64 100 11,134.87 -4,729.23 -6,305.64 -100
IANCE
TOTAL
###
RECONCILIATION BILLING ISSUES

Agency 1000002351
Broker Report
Run Date

BILLING
POLICYNO BP NO LASTNAME FIRSTNAME MI PFX DUEDATE PS
BILLING REMITTANCE VARIANCE
GS EC TOTAL PS GS EC TOTAL PS GS EC
IANCE REMARKS ADJUSTMENTS RECONCILED DEFICIENCY BILLING
TOTAL ISSUES DATE PS GS EC TOTAL PS GS EC
EFICIENCY BILLING
TOTAL
RECONCILIATION BILLING ISSUES

Agency
Broker Report
Run Date

BILLING
POLICYNO BP NO LASTNAME FIRSTNAME MI PFX DUEDATE PS
BILLING REMITTANCE VARIANCE
GS EC TOTAL PS GS EC TOTAL PS GS EC
IANCE
TOTAL
RECONCILIATION BILLING ISSUES

Agency
Broker Report
Run Date

BILLING
POLICYNO BP NO LASTNAME FIRSTNAME MI PFX DUEDATE PS
BILLING REMITTANCE VARIANCE
GS EC TOTAL PS GS EC TOTAL PS GS EC
IANCE
TOTAL REMARKS
 REPUBLIKA NG PILIPINAS
PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN
(GOVERNMENT SERVICE INSURANCE SYSTEM)
Financial Center, Pasay City 1308

RECONCILIATION BILLING SUMMARY

RBS Control No: RBI-RO-2013-02-0000142

January 14, 2018

The Chief Accounting Officer

NFA GEN SANTOS RO XI
LAGAO ROAD, GEN. SANTOS CITY

Dear Ma'am / Sir,

Our records show that you have under-remitted or failed to pay the correct amount of Compulsory Premiums for the month of
January 2012February 2013

Attached is the Reconciliation Billing Issues (RBI) showing the details of underpayment or no payment on compulsory premium of
your employees. We are giving you five (5) days to reconcile with our Billing and Collection Department, otherwise, please pay
immediately the total amount indicated below to avoid incurring interest and penalties.

UNPAID AMOUNT
RBI NUMBER DUE MONTH COMPULSORY PREMIUM
PS GS EC TOTAL
RBI-RO-2013-02-0000142 February-13 - - - -

TOTAL - - - -

Please be reminded of your obligation under Section 6, Paragraph (a) of R.A. 8291, to wit: "the employer shall deduct each month from the
monthly salary or compensation of each employee the contribution payable by him in accordance with the schedule prescribed in the rules and regulations
implementing this act." Failure to do so will constrain the GSIS to enforce the penalties prescribed under Section 52, Paragraphs (c) &
(d) of the GSIS Act of 1997.

To schedule our reconciliation and for further inquiries, please visit our GSIS Billing and Collection Unit, or call us at Telephone
Number _________. You can also email us at __________@gsis.gov.ph.

Thank you for your usual support and cooperation.

Very truly yours,

GSIS Billing and Collection Unit

Note: This is a system generated report which does not require a signature.

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RBS FORM
To be accomplished by RA and BCU representatives as a result of reconciliation.

RECONCILED Deficient Amount on Compulsory Premium

RBI NUMBER DUE MONTH
PS GS EC TOTAL
RBI-RO-2013-02-0000142 February-13

Please pay the total reconciled amount before ___________________.

Conforme:

GSIS REPRESENTATIVE AGENCY AUTHORIZED REPRESENTATIVE

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