Philam Life OFFICIAL RECEIPT

17/F Net Lima Bldg, 5th Ave. corner 26th St., Bonifacio Global City, Taguig City
000-803-117-000
1112-116-00228-CBA/AR
OR No. CS01411237
RECEIVED FROM TIN: RECEIPT DATE: 11/07/2017 18:07:57
MIDRIROS R LUMAAD EFF DATE: 10/12/2004 PD TO DATE: 10/12/2009
MIDRIROS R LUMAAD AGENT CODE FACE AMOUNT: 2,000,000.00
BLK22 LT38 007047549 DAVAO-EVANGELISTA AGENCY
VILLA SENORITA
MAA
PAYMENT FOR REF NO. 1006162862 AMOUNT
VAT-Exempt Sales
Loan Interest 10,000.00
0.00
0.00
0.00
VATable Sales 0.00
Zero-rated Sales 0.00
12% VAT 0.00

PARTICULARS/PAYMENT FORM: TOTAL VAT: 0.00

TOTAL 10,000.00

CM/BANK/TPA REMIT IMPORTANT: See reverse side

B23K/EBC hereof for Terms and Conditions
TP (Csh) 11/07/2017
10,000.00
System Generated receipt, no signature required
QR-CSH-ORV/Rev. 0/ October 2007 PHILAM LIFE CUSTOMER CONFIDENTIAL
 OFFICIAL RECEIPT TERMS AND CONDITION

1. This receipt shall not be binding upon the Company for any part of the said payment covered by check or any form of remittance other
than cash unless such remittance is promptly honored on presentment for payment.

2. This receipt shall produce legal effects only if the payments is in cash or is otherwise duly validated and/or credited to a Company bank
account.

3. If this payment is not acceptable for the purpose it is offered, it will be returned in the normal course of business.

4. No person, except an executive officer of the Company is authorized to make, alter or discharge contracts or waive forfeitures.