Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

www.philhealth.gov.ph

Date/Time Generated : 03/10/2020 08:37:26

SPA No : SPA100021146468
Applicable Period : 02-2020
Report Type : Regular
EMPLOYEES PREMIUM REMITTANCE LIST
PhilHealth Number : 005000006834
Employer Name : DRIVENET COMMUNICATION SYSTEM INC
Employer Address : URDANETA PANGASINAN
Employer TIN : 007195250002
Employer Type : Private
No. PhilHealth No. Surname Given Name Middle Name PS ES Status | Remarks
1 050502765229 ACOSTA JESSIE null 150.00 150.00 A

2 050256036263 CABUAG ROCELLE GUARDIARIO 150.00 150.00 A

3 050501411040 DELA VEGA GORGONIO MARQUEZ 150.00 150.00 A

4 050253339648 ERJAS MANILYN FINADO DEL 150.00 150.00 A

5 050503118995 GODOY RONALD null 150.00 150.00 A

6 020501408728 MACAALAY VIRGILIO CAOILE 150.00 150.00 A

7 050502810135 MARGALLO ARTHUR VILLA 0.00 0.00 NE

8 050501629895 SERRAN WILFREDO UNGOS 150.00 150.00 A

9 050250478701 ZALSOS GRACE DE GUZMAN 375.00 375.00 A

10 050500650297 ZALSOS JOSE GUADALUPE VILLANEA 375.00 375.00 A

Subtotal 1,800.00 1,800.00

GRAND TOTAL 3,600.00

Prepared by : Certified True and Correct by :

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