TRANSMITTAL LETTER

Date: APRIL 12, 2011

Employer PHIC No. 152326000002

Remitting Unit LGU TAFT

Address TAFT, E. SAMAR

Period Covered 1ST QTR 2011

Month Personal Share Employer Share Amt. Remitted ME5/PBR/OR No. Date Paid No. of Employees

JANUARY 10,312.50 10,312.50 20,625.00 77

FEBRUARY 10,312.50 10,312.50 20,625.00 28324637 4/13/2011 77
MARCH 10,312.50 10,312.50 20,625.00 77

CERTIFIED CORRECT AND PAID: To be filled-up by PhilHealth Personnel

Received by:______________________

FRANCISCA B. CHICANO Date Received:____________________

Municipal Treasurer
Document Control No.______________
 EMPLOYER'S FOR PH ILH EALTH USE

RF1 QUARTERLY
REMITTANCE
Date Screened:
By:
Action taken: Date Received:
By:
REPORT Signature over Printed Name Signature Over Printed Name

PHILHEALTH NO. 152326000002

EMPLOYER TIN
EMPLOYER SSS

EMPLOYER NAME : MUNICIPAL GOVERNMENT OF TAFT EMPLOYER TYPE: G GOVERNMENT APPLIC

MAILING ADDRESS : TAFT E SAMAR TYPE OF REPORT: R REGULAR RF1
Tel. No. :
BRACKET NHIP PREMIUM CONTRIBUTIONS
NAME OF EMPLOYEES MONTHLY 1ST MONTH 2ND MONTH
SURNAME GIVEN NAME MI PIN/SSS 1ST 2ND 3RD PS ES PS ES
1 ABENIO IMELDA GERTRUDES ADAL 130000216411 32 32 32 437.50 437.50 437.50 437.50
2 ACAIN HERMINIA ADAO 130000442063 6 6 6 112.50 112.50 112.50 112.50
3 ACAYEN JULIUS IAN M. 132004631777 4 4 4 87.50 87.50 87.50 87.50
4 ACODESIN THELMA DAYMIEL 130000442071 4 4 4 87.50 87.50 87.50 87.50
5 ADA ELIZABETH DANOS 130000442098 5 5 5 100.00 100.00 100.00 100.00
6 ADA MARISSA S. 130001089464 4 4 4 87.50 87.50 87.50 87.50
7 ADENIT VENILDA CEBLANO 130000442144 5 5 5 100.00 100.00 100.00 100.00
8 ADENIT VERGILIIO DERILO 130000442152 4 4 4 87.50 87.50 87.50 87.50
9 ADIGUE ELENA TANINAS 130001057511 25 25 25 350.00 350.00 350.00 350.00
10 AGRAVANTE LUISITO 130001120841 0 0 4 - - - -
11 ALEGRE DANILO CIDRO 130000442500 7 7 7 125.00 125.00 125.00 125.00
12 AQUIATAN SOLOMON 132005599796 0 0 4 - - - -
13 AQUINO LEONARDO SACO 130000813525 4 4 4 87.50 87.50 87.50 87.50
14 ASERIT ANGELITA CEBLANO 130000442179 8 8 8 137.50 137.50 137.50 137.50
15 BACULA LUZ SIMBORIOS 130000442497 5 5 5 100.00 100.00 100.00 100.00
16 BALATO FLORLINO LUBAT 130000476960 4 4 4 87.50 87.50 87.50 87.50
17 BALBABOCO MARIA PAGOTPOT 130000442535 4 4 4 87.50 87.50 87.50 87.50
18 BALBABOCO ALEX COSO 132006876459 4 4 4 87.50 87.50 87.50 87.50
19 BALDOMAR PRIMA B. 130001089472 5 5 5 100.00 100.00 100.00 100.00
20 BALDONIDO ZENAIDA BANTILAN 130000442543 25 25 25 350.00 350.00 350.00 350.00
21 BALIBAG MA. ALMA DOCENA 130250941286 25 25 25 350.00 350.00 350.00 350.00
22 BALICHA GUIO B. 130000442578 4 4 4 87.50 87.50 87.50 87.50
23 BALMES ERWENIA POMIDA 130000442594 15 15 15 225.00 225.00 225.00 225.00
24 BARIS RHODA COSIPAG 130001026411 25 25 25 350.00 350.00 350.00 350.00
25 BEDIASAY ENRICO DIAZ 130000442616 4 4 4 87.50 87.50 87.50 87.50
26 CABANGONAY PABLO DACLES 130000442632 4 4 4 87.50 87.50 87.50 87.50
Page 2 of 11
27 CASPE LITO COFUENTES 130001057546 4 4 4 87.50 87.50 87.50 87.50
28 CEBLANO GIL ADINA 130000442667 6 6 6 112.50 112.50 112.50 112.50
29 CEBLANO ROMMEL RODRIGO DE PADUA 130001037448 25 25 25 350.00 350.00 350.00 350.00
30 CEBLANO FERNANDA CHERREGUNIE 130000179656 17 17 17 250.00 250.00 250.00 250.00
31 CEBREROS CARMENCITA IRASGA 130000442675 13 13 13 200.00 200.00 200.00 200.00
32 CEBREROS ABEL COSO 130000639363 25 25 25 350.00 350.00 350.00 350.00
33 CEBREROS LOPE ADALIM 130000454851 25 25 25 350.00 350.00 350.00 350.00
34 CEBREROS OFILIA DOCENA 130000442683 25 25 25 350.00 350.00 350.00 350.00
35 CEBREROS VIRGILIO B. 130000193195 25 25 25 350.00 350.00 350.00 350.00
36 CEBUANO CECELIO C 130001090586 4 4 4 87.50 87.50 87.50 87.50
37 CHERREGUINE JESUS ADAL 130000442713 4 4 4 87.50 87.50 87.50 87.50
38 CHERREGUINE JESUS AQUIATAN 130000442748 4 4 4 87.50 87.50 87.50 87.50
39 CHICANO DENNIS SULSE 130000874516 4 4 4 87.50 87.50 87.50 87.50
40 CHICANO REYNALDO DOCENA 130000791076 4 4 4 87.50 87.50 87.50 87.50
41 CO THOMAS WILMER TY 130500231859 25 0 0 350.00 350.00 - -
42 COFUENTES LORNA DANGCO 132005595049 4 4 4 87.50 87.50 87.50 87.50
43 COSO EDUARDO BARLONGAY 130000476979 4 4 4 87.50 87.50 87.50 87.50
44 COSO NORA BALATAY 130000964981 25 25 25 350.00 350.00 350.00 350.00
45 DACUYAN ERIC ADAL 130000454878 4 4 4 87.50 87.50 87.50 87.50
46 DACUYAN NORMA A 130000798836 25 25 25 350.00 350.00 350.00 350.00
47 DIADULA CELESTINO BALMES 130000454878 4 4 4 87.50 87.50 87.50 87.50
48 DOCENA SONIA DELOS SANTOS 130000442829 13 13 13 200.00 200.00 200.00 200.00
49 DOCENA CLARITA COFUENTES 130000442810 13 13 13 200.00 200.00 200.00 200.00
50 DOCENA ERENE V. 130000443027 7 7 7 125.00 125.00 125.00 125.00
51 DOCENA REX 130001127234 0 0 4 - - - -
52 DOCENA RONNEL S. 130001089480 4 4 4 87.50 87.50 87.50 87.50
53 DOCIL MARIROZEL CIDRO 130000833607 4 4 4 87.50 87.50 87.50 87.50
54 EBIT ANACLITO C. 130000442845 4 4 4 87.50 87.50 87.50 87.50
55 ELLE JESSICA D. 130001101685 7 7 7 125.00 125.00 125.00 125.00
56 ESPLAGO GERRY HERMANO 130000798879 25 25 25 350.00 350.00 350.00 350.00
57 ESPORAS FRANCISCO E. 130000442853 4 4 4 87.50 87.50 87.50 87.50
58 EVIDENTE AIDA DOCULARA 130000442861 4 4 4 87.50 87.50 87.50 87.50
59 FABILLAR ARTEMIO PACAWAY 132005595898 4 4 4 87.50 87.50 87.50 87.50
60 FLOSA JASPER LOUIE BALIAT 130000539261 25 25 25 350.00 350.00 350.00 350.00
61 GUASIS RHEA COPRADA 130000753654 4 4 4 87.50 87.50 87.50 87.50
62 LARA PEDRO 130001127250 0 0 4 - - - -
63 LIBANAN SOL ANGELIE E. 25 25 25 350.00 350.00 350.00 350.00
64 LIM DIEGO TANINAS 130000639320 31 31 31 425.00 425.00 425.00 425.00
65 MACEDA ANITA C 130001089499 4 4 4 87.50 87.50 87.50 87.50
66 MAGRO ADOLF PHILIP ABDON 0 0 4 - - - -
67 MINGULLO RAUL AQUIATAN 130000442918 6 6 6 112.50 112.50 112.50 112.50
68 MURAYAO EVELYN BALMES 130000867285 4 4 4 87.50 87.50 87.50 87.50
Page 3 of 11
69 ORITA MAX ANTHONY BALEIN 130000442926 4 4 4 87.50 87.50 87.50 87.50
70 ORITA JORGE PERMITES 130000476987 6 0 0 112.50 112.50 - -
71 PENAFLOR DOLORES AMBIDA 130000442934 6 6 6 112.50 112.50 112.50 112.50
72 PICO TILBERT GECOMO 130000791092 5 5 5 100.00 100.00 100.00 100.00
73 PLAZA VILMA OBAYAN 130000442942 5 5 5 100.00 100.00 100.00 100.00
74 POMIDA MARLENE CIEGO 130000753670 4 4 4 87.50 87.50 87.50 87.50
75 QUINTO RAYMUNDOS ASEO 130000747948 7 7 7 125.00 125.00 125.00 125.00
76 QUINTUA ATHELIA L 130251089362 21 21 21 300.00 300.00 300.00 300.00
77 SIMBALLA EDWIN B. 130001089502 4 4 4 87.50 87.50 87.50 87.50
78 SULSE VILMA OSIT 130000442968 25 25 25 350.00 350.00 350.00 350.00
79 SUYO EDUARDO DOCIL 130000796310 4 4 4 87.50 87.50 87.50 87.50
80 TANINAS ERNESTO CEBRICUS 130000442985 4 4 4 87.50 87.50 87.50 87.50
81 TANINAS RODRIGO VISTA 130000442993 4 4 4 87.50 87.50 87.50 87.50
82 TANINAS EMMA LIM 130000442977 4 4 4 87.50 87.50 87.50 87.50
83 ULTRA ESTER DIANA 130000443019 7 7 7 125.00 125.00 125.00 125.00
84 VELASCO ELISA COFUENTES 130000491161 5 5 5 100.00 100.00 100.00 100.00
85 VISTA RUFO CHU 130000443035 25 25 25 350.00 350.00 350.00 350.00
86 ZACATE LUCIA SINGUA 130000443043 25 25 25 350.00 350.00 350.00 350.00
SUBTOTAL 13800.00 13800.00 13337.50 13337.50
(PS+ES) 27600.00 26675.00

CERTIFIED CORRE
ME5 SUMMARY OF CONTRIBUTION PAYMENTS No. of
Monthly/Quarterly Total Contribution Rec. no./Date Paid Employees
1st Month 27,600.00 81
2nd Month 26,675.00 79
3rd Month 27,550.00 84
81825

Page 4 of 11
E

er Printed Name

APPLICABLE QUARTER: 1
YEAR: 2013

RIBUTIONS
3RD MONTH REMARKS
PS ES SSeparated, NENo Earnins, NHNewly Hired

437.50 437.50
112.50 112.50
87.50 87.50
87.50 87.50
100.00 100.00
87.50 87.50
100.00 100.00
87.50 87.50
350.00 350.00
87.50 87.50
125.00 125.00
87.50 87.50
87.50 87.50
137.50 137.50
100.00 100.00
87.50 87.50
87.50 87.50
87.50 87.50
100.00 100.00
350.00 350.00
350.00 350.00
87.50 87.50
225.00 225.00
350.00 350.00
87.50 87.50
87.50 87.50
Page 5 of 11
 87.50 87.50
112.50 112.50
350.00 350.00
250.00 250.00
200.00 200.00
350.00 350.00
350.00 350.00
350.00 350.00
350.00 350.00
87.50 87.50
87.50 87.50
87.50 87.50
87.50 87.50
87.50 87.50
- -
87.50 87.50
87.50 87.50
350.00 350.00
87.50 87.50
350.00 350.00
87.50 87.50
200.00 200.00
200.00 200.00
125.00 125.00
87.50 87.50
87.50 87.50
87.50 87.50
87.50 87.50
125.00 125.00
350.00 350.00
87.50 87.50
87.50 87.50
87.50 87.50
350.00 350.00
87.50 87.50
87.50 87.50
350.00 350.00
425.00 425.00
87.50 87.50
87.50 87.50
112.50 112.50
87.50 87.50
Page 6 of 11
 87.50 87.50
- -
112.50 112.50
100.00 100.00
100.00 100.00
87.50 87.50
125.00 125.00
300.00 300.00
87.50 87.50
350.00 350.00
87.50 87.50
87.50 87.50
87.50 87.50
87.50 87.50
125.00 125.00
100.00 100.00
350.00 350.00
350.00 350.00
13775.00 13775.00
27550.00

TIFIED CORRECT: DOLORES A. PEÑAFLOR

Signature over Printed Name
MUNICIPAL ACCOUNTANT
Official Designation

Date

Page 7 of 11
 EMPLOYER'S FOR PH ILH EALTH USE

RF1 QUARTERLY
REMITTANCE
Date Screened:
By:
Action taken: Date Received:
By:
REPORT Signature over Printed Name Signature Over Printed Name

PHILHEALTH NO. 019000003788

EMPLOYER TIN
EMPLOYER SSS

EMPLOYER NAME : FARMACIA IRENE EMPLOYER TYPE: G GOVERNMENT APPLICAB

MAILING ADDRESS : GEN. MACARTHUR, EASTERN SAMAR TYPE OF REPORT: R REGULAR RF1
Tel. No. :
BRACKET NHIP PREMIUM CONTRIBUTIONS
NAME OF EMPLOYEES MONTHLY 1ST MONTH 2ND MONTH
SURNAME GIVEN NAME MI PIN/SSS 1ST 2ND 3RD PS ES PS ES
1 SUMEGUIN PAZ NORTE 190897399125 4 4 4 87.50 87.50 87.50 87.50
2 TAN IMELDA CARSIDO 190897399133 4 4 4 87.50 87.50 87.50 87.50
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
 SUBTOTAL 175.00 175.00 175.00 175.00
(PS+ES) 350.00 350.00

CERTIFIED CORRECT:
ME5 SUMMARY OF CONTRIBUTION PAYMENTS No. of
Monthly/Quarterly Total Contribution Rec. no./Date Paid Employees
1st Month 350.00 2
2nd Month 350.00 2
3rd Month 350.00 2
rinted Name

APPLICABLE QUARTER: 1
YEAR: 2013

BUTIONS
3RD MONTH REMARKS
PS ES SSeparated, NENo Earnins, NHNewly Hired

87.50 87.50
87.50 87.50
 175.00 175.00
350.00

ED CORRECT: IDA C. LUCERO

Signature over Printed Name
OWNER
Official Designation

Date