IMMA CON SCHOOL OF DAVAO

Sampaguita St., Brgy. Ubalde, R Castillo Agdao Davao City

CERTIFICATE OF PREMIUM PAYMENT

This is to certify that Ms. Crycel S. Dapat is an employee of Imma Con School of Davao with
Philhealth Number 160256802896.
She has made the following remittance to wit:

Name of Employer: IMMA CON SCHOOL OF DAVAO INC.

PHIC Number of the Employer : 016000013519

Name of Member: Crycel S. Dapat

PHIC Number of the Member :160256802896

Applicable Amount Paid OR Number Date of Status

Month Payment

September 3,850.00 320929575 10/12/2018 Posted

2018

October 2018 4,400.00 320929744 11/23/2018 Posted

November 2018 4,600.00 320929822 12/17/2018 Posted

December 2018 4,400.00 320929901 1/11/2019 Posted

January 2019 4,600.00 320930052 3/4/2019 Posted

February 2019 4,400.00 320930060 3/6/2019 Posted

March 2019 4,400.00 320930319 5/21/2019 Posted

April 2019 1,100.00 323336313 8/14/2019 Paid

May 2019 1,100.00 323336314 8/14/2019 Paid

June 2019 4,325.00 320930458 7/11/2019 Posted

July 2019 4,325.00 323336315 8/14/2019 Paid

This certification is being issued to Ms. Dapat for her hospitalization claim purposes.

Issued this 15th day of August 2019 at Imma Con School of Davao, Sampaguita Street,
Brgy Ubalde, R. Castillo Agdao, Davao City.

Certified by:

LIGAYA B. IGNACIO
SCHOOL ADMIN EXECUTIVE