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 : 001000035144 SPA No. : SPA100006987933

Employer Type : Private Date Generated : Oct 01, 2016
Business/Agency Name : THE NEW YUMENONAKAE CORP
Premium Due Date:
Group Account Name: Please Pay Immediately

CURRENT CHARGES:
Applicable Month : September 2016
No. of Employees : 4
Amount of Premium:
Employee Share 562.50
Employer Share 562.50
Premium Due for the Current Applicable Period 1,125.00
TOTAL AMOUNT DUE 1,125.00

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
SPA100005129354 Feb 2016 1,375.00
SPA100006052257 Jun 2016 1,375.00
SPA100006671386 Aug 2016 1,125.00
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. : SPA100006987933
Date Generated : Oct 01, 2016
PEN : 001000035144 Employer Type : Private
Business/Agency Name : THE NEW YUMENONAKAE CORP
Applicable Month : September 2016 No. of Employees : 4

Principal Grouping No:

Principal Name:

Amount of Premium:
Employee Share 562.50
Employer Share 562.50
Premium Due for the Current Applicable Period 1,125.00
TOTAL AMOUNT DUE 1,125.00