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Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION
www.philhealth.gov.ph

SPA No. : SPA100011184821
Applicable Period : 09-2017
Document Control Number : 015050000039313534465
Date/Time Generated : 08/08/2018 10:34:25
Date Received : 10/10/2017 11:46:42
Report Type : Regular
EMPLOYER'S REMITTANCE REPORT
PhilHealth Number : 015050000039
Employer Name : ADVENTIST TECHNOLOGICAL INSTITUTE
Employer Address : JIMENEZ MISAMIS OCCIDENTAL
Employer TIN : 006080849
Employer Type : Private
No. PhilHealth No. Surname Given Name Middle Name PS ES Status | Remarks
1 150254040357 ACMAD ROMEL BRYAN LIMBAROC 100.00 100.00 A
2 142015464967 HILOT MADELYN VELASCO 100.00 100.00 A
3 152019299575 LOMO I VIOLIZA LIMBARO 100.00 100.00 A
4 150254146872 MAGHUYOP ANGIE FUERTES 100.00 100.00 A
5 142014039448 PROCESO EDU ELUMBARING 100.00 100.00 A
6 190500205338 QUIZA ALBERT DAMPOR 187.50 187.50 A
7 090000553157 QUIZA ALVIN LOU MAGHUYOP 100.00 100.00 A
8 190500205362 QUIZA LOURDES MAGHUYOP 187.50 187.50 A
9 190897430391 REVELO LOVERE GOZO 100.00 100.00 A
10 140501845775 ROSALES ALDREN ORCALES 100.00 100.00 A
11 150504332634 ROSALES JEAN GLEN URSONAL 100.00 100.00 A
12 150504582126 SAYSON ARJHEL MECA 100.00 100.00 A
13 142514544114 VELASCO ENJELLE FERNANDEZ 100.00 100.00 A

Subtotal 1,475.00 1,475.00
GRAND TOTAL 2,950.00

Remitted Amount : 2,950.00
POR No. : 313534465
Transaction Date : 10/09/2017
No. of Employees : 13
Status Report : Posted
Date Posted : 12/12/2017

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