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Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION


www.philhealth.gov.ph

Date/Time Generated : 05/10/2018 07:42:22


SPA No : SPA100013593967
Applicable Period : 05-2018
Report Type : Regular
EMPLOYEES PREMIUM REMITTANCE LIST
PhilHealth Number : 010050001487
Employer Name : OWENG ELECTRICALSUPPLY
Employer Address : CORNER SAN VICENTE ST BARANGAY II (POB.) VINZONS CAMARINES NORTE
Employer TIN : 904971612
Employer Type : Private
No. PhilHealth No. Surname Given Name Middle Name PS ES Status | Remarks
1 100502579554 DEL BARRIO MICHELLE MAIGUE 137.50 137.50 A

Subtotal 137.50 137.50


GRAND TOTAL 275.00

Prepared by : Certified True and Correct by :

Signature over Printed Name and Designation Signature over Printed Name and Designation

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