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 : 001010004310 SPA No. : SPA100009251892

Employer Type : Private Date Generated : Apr 15, 2017
Business/Agency Name : PHILOXENIA TRAVEL AND TOURS
Premium Due Date:
Group Account Name: Please Pay Immediately

CURRENT CHARGES:
Applicable Month : March 2017
No. of Employees : 2
Amount of Premium:
Employee Share 350.00
Employer Share 350.00
Premium Due for the Current Applicable Period 700.00
TOTAL AMOUNT DUE 700.00

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
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. : SPA100009251892
Date Generated : Apr 15, 2017
PEN : 001010004310 Employer Type : Private
Business/Agency Name : PHILOXENIA TRAVEL AND TOURS
Applicable Month : March 2017 No. of Employees : 2

Principal Grouping No:

Principal Name:

Amount of Premium:
Employee Share 350.00
Employer Share 350.00
Premium Due for the Current Applicable Period 700.00
TOTAL AMOUNT DUE 700.00