Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

www.philhealth.gov.ph

SPA No. : SPA100007085393

Applicable Period : 09-2016
Document Control Number : 001010004310313502430
Date/Time Generated : 10/29/2016 13:21:31
Date Received : 10/21/2016 19:46:21
Report Type : Regular
EMPLOYER'S REMITTANCE REPORT
PhilHealth Number : 001010004310
Employer Name : PHILOXENIA TRAVEL AND TOURS
Employer Address : MANDALUYONG CITY SECOND DISTRICT
Employer TIN : 273628053
Employer Type : Private
No. PhilHealth No. Surname Given Name Middle Name PS ES Status | Remarks
1 010520386535 BASCOS PRINCESS CAROLINE PALAD 225.00 225.00 A
2 030260029270 SORIANO KHEA MYLES FRANCISCO 0.00 0.00 S 08/31/2016

Subtotal 225.00 225.00

GRAND TOTAL 450.00

Remitted Amount : 450.00

POR No. : 313502430
Transaction Date : 10/20/2016
No. of Employees : 2
Status Report : Posted
Date Posted : 10/24/2016

This is an EPRS generated Employer Remittance Report. Certification of employer is not required.