Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

www.philhealth.gov.ph

SPA No. : SPA100017223241

Applicable Period : 03-2019
Document Control Number : 019000021060315258490
Date/Time Generated : 11/08/2019 11:45:44
Date Received : 05/10/2019 22:37:25
Report Type : Regular
EMPLOYER'S REMITTANCE REPORT
PhilHealth Number : 019000021060
Employer Name : CSP DIGITAL IMAGE CORPORATION
Employer Address : COTABATO CITY MAGUINDANAO
Employer TIN : 007431903
Employer Type : Private
No. PhilHealth No. Surname Given Name Middle Name PS ES Status | Remarks
1 020263826370 CONCEPCION FRANCIS CARL VILLALBA 137.50 137.50 A
2 160506891776 FLORES ESTRELLITA FILOSOFO 137.50 137.50 A
3 170253262802 HERRERA DEE HAJJI UY 137.50 137.50 A
4 170501385061 HERRERA DEE HARVEY UY 137.50 137.50 A
5 030258312232 HERRERA DEE HOWELL UY 137.50 137.50 A
6 030509758804 IMPERIAL MELANIE ROMO 137.50 137.50 A
7 020260238729 NACION JR GERRY TANO 0.00 0.00 S 03/01/2019

Subtotal 825.00 825.00

GRAND TOTAL 1,650.00

Remitted Amount : 1,650.00

POR No. : 315258490
Transaction Date : 04/10/2019
No. of Employees : 7
Status Report : Posted
Date Posted : 05/11/2019

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