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

Date generated : July 02, 2018
PEN: 001020006476
Employer Type : PRIVATE SPA100014115046
Business/Agency Name : BRAND REPUBLIC MARKETING & MANPOWER SERVICES INC

Group Name :

CURRENT CHARGES :
Applicable Month : June 2018
No. of Employees : 18

Amount of Premium:
Employee Share : 4,166.25
Employer Share : 4,166.25

Premium Due for the Current Applicable Period 8,332.50

Add: Interests and/or Surcharges Incurred for the Previous 200.00

Applicable Month SPA Number Amount Date of Payment PAR/POR No. Interest
Apr 2018 SPA100013854741 8,057.50 06/06/2018 319062036 200.00

Due Date:
TOTAL AMOUNT DUE 8,532.50 Please Pay Immediately

IMPORTANT REMINDER
Per available records, it appears that your account has deficiencies as follows:

Reference Deficiency Applicable Month/s Amount

SPA100007607779 No Premium payment Jun 2016 675.00
SPA100011633403 No Premium payment Oct 2017 2,000.00
SPA100014115046 No Premium payment Jun 2018 8,532.50
No SPA generated Jun 2015
No SPA generated Jul 2015
No SPA generated Aug 2015
No SPA generated Sep 2015
No SPA generated Oct 2015
No SPA generated Nov 2015
No SPA generated Dec 2015
No SPA generated Feb 2016
No SPA generated Mar 2016
No SPA generated Apr 2016
No SPA generated May 2016

Please settle the above deficiencies immediately as indicated. All reports must be posted within five (5) days after payment.
For assistance, coordinate with the PAIMS assigned to your account or visit the nearest PhilHealth Office. Thank you.
 Date generated : July 02, 2018
PEN: 001020006476
Employer Type : PRIVATE SPA100014115046
Business/Agency Name : BRAND REPUBLIC MARKETING & MANPOWER SERVICES INC

Group Name :

CURRENT CHARGES :
Applicable Month : June 2018
No. of Employees : 18

Amount of Premium:
Employee Share : 4,166.25
Employer Share : 4,166.25

Premium Due for the Current Applicable Period 8,332.50

Add: Interests and/or Surcharges Incurred for the Previous 200.00

Applicable Month SPA Number Amount Date of Payment PAR/POR No. Interest
Apr 2018 SPA100013854741 8,057.50 06/06/2018 319062036 200.00

Due Date:
TOTAL AMOUNT DUE 8,532.50 Please Pay Immediately