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

Date generated : November 11, 2019
PEN: 016000015300
Employer Type : PRIVATE SPA100019714348
Business/Agency Name : LEINAHTAN NET CAFE & REPAIR SERVICES-MARJUNE C
DIMAYUGA

Group Name :

CURRENT CHARGES :
Applicable Month : October 2019
No. of Employees : 4

Amount of Premium:
Employee Share : 550.00
Employer Share : 550.00

Premium Due for the Current Applicable Period 1,100.00

Due Date:
TOTAL AMOUNT DUE 1,100.00 Please Pay Immediately

IMPORTANT REMINDER
Per available records, it appears that your account has deficiencies as follows:

Reference Deficiency Applicable Month/s Amount

SPA100004217934 No Premium payment Oct 2015 1,200.00
SPA100012383864 No Premium payment Jan 2018 950.00
SPA100012782345 No Premium payment Feb 2018 550.00
SPA100013263637 No Premium payment Mar 2018 550.00
SPA100013499314 No Premium payment Apr 2018 550.00
SPA100013824122 No Premium payment May 2018 1,100.00
SPA100014210893 No Premium payment Jun 2018 1,100.00
SPA100014499182 No Premium payment Jul 2018 1,375.00
SPA100014882636 No Premium payment Aug 2018 1,375.00
SPA100015246670 No Premium payment Sep 2018 1,375.00
SPA100015576468 No Premium payment Oct 2018 1,375.00
SPA100015819558 No Premium payment Nov 2018 1,375.00
SPA100016563007 No Premium payment Dec 2018 1,375.00
SPA100016563030 No Premium payment Jan 2019 1,375.00
SPA100016930550 No Premium payment Feb 2019 1,375.00
SPA100017296399 No Premium payment Mar 2019 1,100.00
SPA100017540037 No Premium payment Apr 2019 1,100.00
SPA100017950736 No Premium payment May 2019 1,100.00
SPA100018324893 No Premium payment Jun 2019 1,100.00
SPA100018753253 No Premium payment Jul 2019 1,100.00
SPA100019215857 No Premium payment Sep 2019 1,100.00
No SPA generated Aug 2019

Please settle the above deficiencies immediately as indicated. All reports must be posted within five (5) days after payment.
For assistance, coordinate with the PAIMS assigned to your account or visit the nearest PhilHealth Office. Thank you.
 Date generated : November 11, 2019
PEN: 016000015300
Employer Type : PRIVATE SPA100019714348
Business/Agency Name : LEINAHTAN NET CAFE & REPAIR SERVICES-MARJUNE C
DIMAYUGA

Group Name :

CURRENT CHARGES :
Applicable Month : October 2019
No. of Employees : 4

Amount of Premium:
Employee Share : 550.00
Employer Share : 550.00

Premium Due for the Current Applicable Period 1,100.00

Due Date:
TOTAL AMOUNT DUE 1,100.00 Please Pay Immediately