Spa Tleung 112016

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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 : 008040005111 SPA No. : SPA100007796525


Employer Type : Private Date Generated : Dec 09, 2016
Business/Agency Name : TLEUNG ENTERPRISES
Premium Due Date:
Group Account Name: Please Pay Immediately

CURRENT CHARGES:
Applicable Month : November 2016
No. of Employees : 12
Amount of Premium:
Employee Share 1,200.00
Employer Share 1,200.00
Premium Due for the Current Applicable Period 2,400.00
TOTAL AMOUNT DUE 2,400.00

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
SPA100007796523 Dec 2016 2,600.00
Jun 2015
Jul 2015
Aug 2015
Sep 2015
Oct 2015
Nov 2015
Dec 2015
Jan 2016
Feb 2016
Mar 2016
Apr 2016
May 2016

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.

................................................................. Cut-off Here .....................................................................

PHILHEALTH EPRS PREMIUM PAYMENT SLIP


Remittance Due Date : Please Pay Immediately SPA No. : SPA100007796525
Date Generated : Dec 09, 2016
PEN : 008040005111 Employer Type : Private
Business/Agency Name : TLEUNG ENTERPRISES
Applicable Month : November 2016 No. of Employees : 12

Principal Grouping No:


Principal Name:

Amount of Premium:
Employee Share 1,200.00
Employer Share 1,200.00
Premium Due for the Current Applicable Period 2,400.00
TOTAL AMOUNT DUE 2,400.00

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