(pls.

use paper with company letter head)

March 5, 2018

MR. JUAN ANDRES S. MONTOYA

Chief Operating Officer
MediCard Philippines, Inc.
11th Floor, The World Centre Bldg.,
Sen. Gil Puyat Avenue,
Makati City

Dear Mr. Montoya:

We are pleased to inform you that we have chosen MediCard Philippines, Inc. as our HMO
provider for a period of one year effective _______________________.

For your reference purposes, we indicate below important details about our Company and the
authorized signatory:

Name of signatory/company Tax Identification Issued Government IDs

Number (TIN) (for contract purposes)

Name of Company: Government Issued IDs

TIN: _______________ (SSS No. or GSIS, etc.):
_____________________________ ________________

Contract signatory name: Government Issued IDs

TIN: _______________ (SSS No. or Passport or
_____________________________ Driver’s License etc.):
_____________
Designation/Position:

_____________________________

We look forward to a better and harmonious working relationship with you.

Very truly yours,

Name
(designation or position)