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 : 001020005750 SPA No. : SPA100008901938

Employer Type : Private Date Generated : Mar 13, 2017
Business/Agency Name : DUMI'T MANTSA LAUNDRY & DRY CLEAN SHOP
Premium Due Date:
Group Account Name: Please Pay Immediately

CURRENT CHARGES:
Applicable Month : February 2017
No. of Employees : 5
Amount of Premium:
Employee Share 500.00
Employer Share 500.00
Premium Due for the Current Applicable Period 1,000.00
TOTAL AMOUNT DUE 1,000.00

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
SPA100008392140 Jul 2016 1,000.00
SPA100008392141 Aug 2016 1,000.00
SPA100008392182 Sep 2016 1,000.00
SPA100008392183 Oct 2016 1,000.00
SPA100008392184 Nov 2016 1,000.00
SPA100008392203 Dec 2016 1,000.00
SPA100008392204 Jan 2017 1,000.00
Jun 2015
Jul 2015
Aug 2015
Sep 2015
Oct 2015
Nov 2015
Dec 2015
Jan 2016
Feb 2016
Mar 2016
Apr 2016
May 2016
Jun 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. : SPA100008901938
Date Generated : Mar 13, 2017
PEN : 001020005750 Employer Type : Private
Business/Agency Name : DUMI'T MANTSA LAUNDRY & DRY CLEAN SHOP
Applicable Month : February 2017 No. of Employees : 5

Principal Grouping No:

Principal Name:

Amount of Premium:
Employee Share 500.00
Employer Share 500.00
Premium Due for the Current Applicable Period 1,000.00
TOTAL AMOUNT DUE 1,000.00