FiLe name : R30809469?32052020.

07101015
Enployer name: TAGOLOAN POLYMEDIC GENERAL HOS Date: Ju.1- 70, 2O2O
Employer No : 0I -0 94 697 3-2 App. Period:052020

PAYMENT INFORMATION
TR/SBR NUMBER : H00041502430234
DATE OF PAYMENT : Jun 30, 2020
AMOUNT PAID : 328,640.00

ENCODED INEORMATION
SS AMOUNT : 324, 900.00 ,1
t
EC AI4OUNT i 3,740.00 O7
TOTAL AMOUNT : 328, 64 0. o0 Yeo
Tota.I number of Empl-oyees: 180

CERTIF]ED CORRECT AND PAID /.i (ge._.9

RECEIVED BY :
DATE RECEIVED :
TRANSACTION NO:

OI]EIIiREL a. Rnbn
TAGOLOAN POI,YMEDIC GENERAL HOS [R3080 94 6 9-l 32052020. 01 101015 ]
Date: Jul 10, 2020
EAMILY NAME GIVEN NAME MI SS NUMBER s.s E. C. RMRK
DTHRD

ABARRIENTOS NORFEL B 08-]-263662-0 1440.00 10.00 N

0
ABlSADO GIRLIE MARIE S 33-4039671-4 2400.00 30.00 N
0
ABR]O RALPH PATRICK F 08-2568118-3 1140.00 10. 00 N
0
ACOGI DO HONEY GRACE V 08-2411115-9 1200.00 10. 00 N
0
ACOSTA CARL MARK ANDRE C 08-1936865-8 2400.00 30.00 N
0
AGPAI{A MARIA LIZA CZAR D 08-297\1 49-1, 2400.00 30. 00 N

0
AGBAVANTE WENNA SHEENW S 34-6249060-8 1380.00 10.00 N

0
AIKU I NO CHONA S 08-0880329-2 2400.00 30,00 N

0
AMANDORON JARED BENJIE M 08-1701541-1 2400.00 30.00 N

0
AMPER AIREN C 08-1940208-0 2400.00 30.00 N

0
ANTAO NENA DOMINICA A 08-o72437L-4 2400.00 30. 00 N

0
APARIC] JUANITO JR. A 08-0455321-6 2160.00 30.00 N

0
APLICADOR MARIANNE ROSE P 08-1679043-6 2340.00 30.00 N

0
ARANCES RIXON S 08-7424639-3 1140.00 10. 00 N

0
DARWIN S 08-2587531-3 2340.00 30.00 N
ASARES
0
DIOSCOBA D 08-0?89059-4 2400.00 30.00 N
AYOP
0
ABEL C 09-3344186-2 1200.00 10.00 N
ANASCO
0 10.00
RENATO P 08-1794999-8 1140,00 N
ANASCO
0 30. 00
AIEXIS MARIE D 08-26't 4657 -'1 1850. 00 N
BADIC
0 10.00
ROWENA !,IARLENE A 08-1031139-0 1500.00 N
BAGAYAS
0 10.00 N
CHRISTOPHER S 08-1035419-5 1.320.00
BAHlAN
0 10.00
IAN ANTHONY D 08-1438905-6 1500.00 N
BALDO
0 30.00
SARAH L 08-0686646-4 2400.00 N
BAI,DO
0 2220.O0 30.00 N
BAIENDEZ MA. KARLA B 08-0?70623-5
0 2160 . 00 30.00 N
BATOON REJAE MAE P 34-6596423-8
0 2340.00 30 .00 N
BAZ FEBBIE MARIE R 34-5592385-2
0 2340.00 30.00 N
BEDAYO ROWENA E o8-2t30924-9
0 1620.00 10.00 N
BERGUI,A JULIE ANN M 08-135071-1-4
0
BORRES JOHN BREY S 08-1930959-4 1140.00 10. 00
0
BRADSHAW MARIBETH G 08-1111364-9 2400.00 30. 00
0
BRITOS NEIYA FRANCINE V 08-2339942-2 2160.00 30.00
0
BROBO CARMENCITA D 08-1620939-6 660.00 10.00
0
BUHAYAN CRISTINE E 08-1926966-3 840.00 10.00
0
CABA],LERO MARIA CECILIA D 08-153619?-6 1260.00 10.00
0
CADAVE Z WITEL M 08-1588562-7 2220 .00 30. 00
0
CAGA],AWAN JAN CARLO D 34-4247 953-9 1020.00 10. 00
0
CAINCAY MARDY S 08-19?4436-6 2400.00 30.00
0
CAM .,OHN RED C 08-1?98561-9 1260.00 10.00
0
CAMPOAMOR CLAUDYN KIM C 08-1900808-6 2400.00 30.00
0
CAPIN ADELINE A 06-2!96't 42-5 1140.00 10.00
0
CARPIO ADELITA A 08-09'14299-6 1440.00 10.00
0
CASINO KAYE B 08-1263979-5 2400.00 30.00
0
JESSA E 08-2935516-9 1680.00 10.00
0
CELOCIA MARLENE P 08-0880583-4 1260.00 10.00
0
CENI ZA LOURFRED C 08-1624206-5 2280 .00 30.00
0
CIELO IVAN JUN C 08-1357080-8 1920.00 30. 00
0
COMlNGHOD .]OCELLE 08-165?489-8 1620.00 10.00
0
CONCEPCION DEXTER N o8-2022993-5 2400.00 30.00
0
CONCHA CINDY LOU M 08-1965193-8 2400.00 30.00
0
COPINO ABEGAIL P 08-1991509-8 2160.00 30.00
0
CRUZ ALLYSA A 08-1806420-9 2400.00 30. 00
0
CRUZ KATHERINE T 08-0800948-1 2400.00 30.00
0
DA-A MICHAEL JAY 34-5935087-4 1140.00 10.00
0
DA-AO GAMIL T 08-1624019-3 1140.00 10.00
0
DADO FELYNOR A 08-1374789-3 1680.00 10.00
0
DAGUPAN ROMULO JR. A 08-074 6918 -7 1080.00 10.00
0
DAHAN CHERRYL D 08-2546140-0 2160.00 30.00
0
DALIGCON .]ENNI FER C 02-r52't 403-2 1500.00 10. 00
0
DANlEI, ANNE ROSE B 08-1926203-9 2400.00 30. 00
0
DEJOS DEODORA S 08-0781341-6 2400.00 30.00
0
DETATLA MARIA REYNA B 08-1060609-2 2400.00 30. 00
0
D IANO JOEL Y 08 -14 41400-2 1980.00 30.00
0
DIAZ LYN ABEGAIL B 08-29368't3-2 960.00 10.00
0
DlVINAGRACIA RHEA E 08-2511215-9 1200.00 10.00
0
DTVINAGRACIA ROBERT A 08-),422928-A 1200.00 10.00
0
DOMINGUEZ EDNA B 08-1037304-0 2100.00 30.00
0
DUBI,ADO REGINA.LD G 08-1262695-'7 2400.00 30.00
0
DUITES ANNA LOU E o8-t666241-2 2400.00 30. 00
0
EBDALIN .]ACKNEN O 34-6259491-5 1680.00 10.00
0
EJEI4 ESTELIE DWAYNE 34-8462813-1 900.00 10.00
0
ESTRADA GLEN RYAN E 34-6102853-4 1140.00 10.00
0
FAJARDO ANIONIO JR. O o8-2482704-L 1440.00 10.00
0
FUROG .]ENIE L 08-2758128-1 1680.00 10.00
0
GABU',E ANA JANE S 34-6205173-3 1500.00 10.00
0
GABUIE DAISY MAE R 08-2405688-7 1200.00 10.00
0
GAIAMITON oscAR s 08-1509708-8 1200.00 10.00
0
GAICERAN FELYROSE E 08-r423623-5 840.00 10.00
0
GAI,DO LOVE JOY G 08-1685309-8 2400.00 30. 00
0
GAMAO ELI,AINE P 08-2s332 4 5-8 1800,00 30.00
0
GAMOLO TARA .]ANE 08-1654350-2 2340.00 30. 00
0
GANAS JOYNIE ANGIELYK Z 08-2926260-5 1320. 00 10. 00
0
GASAPO SHAINA JOY L 08-2909333-7 2160.00 30.00
0
GONZAIES CHINO LOU .] 34-5554436-7 1860.00 30.00
0
GORGONIO RATCHELLE M 08-160774?-6 1260.00 10.00
0
HAGTUSAN BERNARD O 08-1448669-0 1080.00 10. 00
0
HlGOTE EDWARD A 33-8574900-9 L080,00 10.00
0
JOSUE JIIL W 34-68s1084-1 840.00 10.00
0
JUAN I l,LO GAIL G 08-1s32735-0 1620. 00 10. 00
0
.]UMALON STEPHANIE B 08-1002867-0 2400.00 30.00
0
LABNOTIN MIRASOI M 08-1041044-0 2400.00 30.00
0
I,ABOR JOSEPHINE G o8-t266529-3 30.00
0
LADRA RODESSA A 34-5't'18954-A 1500.00 10.00
0
LAGUMBAY LINDON W 08-0829945-3 1320.00 10.00
0
LANO EIISA H 08-1066329-7 2400.00 30.00
0
LAPINI D DONNA RIA ROXAN D 34-55135?5-0 2340.00 30. 00
0
LASTIMOSA MAE MARJORY N 06-3013992-7 2400.00 30.00
0
L I RASAN CHARMAINE ANN Y 08-t9684't2-7 2100.00 30.00
0
LLANOS HANNY 08-1999433-6 2400.00 30.00
0
LOB ] DO LILIAN P 08-1018048-2 1980.00 30.00
0
LOOD JUNARY O 08-2514845-1 1320.00 10.00
0
LOPEZ CHAR],ES P 08-1468493-9 1680.00 10.00
0
LOPEZ JOHN MARK M 08-1956310-7 2400.00 30.00
0
MABAYLAN EVELYN M 34-29802't0-5 2400.00 30.00
0
MABELIN MARCHELE T 34-6676138-8 1380.00 10.00
0
MAD,JUS ALISON B 08-2458890-2 2400.00 30.00
0
MADRID KENNETH D 08-L971105-6 2400.00 30.00
0
MAGDA].ES JENNIFER R o8-2314909-6 1740.00 10.00
0
MAGHANOY REYGIE BELIE S 08-2?08235-3 2100.00 30.00
0
MANATAD RYAN D 08-1617068-7 1140.00 10.00
0
MANCAO MARICEL N 08-1915448-0 2100.00 30.00
0
MANCAO RUEL U 08-26L547 6-t 1140.00 10.00
0
MASAYON GINA D 08-0942239-'t 2400.00 30.00
0
MEJORADA CHARLENE ANGELE B 08-2828205-5 2100.00 30.00
0
MINORO JUNAREL Y 08-23'71864-5 840.00 10.00
0
MOCA BENJI B 08-2332194-6 1500.00 10.00
0
MOLDEZ REX M 08-1262234-6 1200.00 10.00
0
MONDIGO SHAWN L 08-2835824-8 780.00 10.00
0
MUEGO JOE MARIE A 34-6052297 -6 1560.00 10.00
0
NAMUAG RENE L 08-0981827-3 2160.00 30.00
0
NERI ANNIE GRACE r 08-1709429-6 2220 .00 30.00 N
0
OI,AMIT EMILY v 08-0974 911-9 1860.00 30. 00 N

OI,ARIO BAINlER P 0I -12 37 8 36-0 1440.00 10. 00 N

0
ONTONG EMERITA s 08-09277 42-9 1800. 00 30.00 N
0
OPELINA I SMAEL D 33-7488052-6 2280 .OA 30.00 N
0
OPELlfiA LARRY D 08-1534902-4 1200.00 10.00 N
0
OPELINA ROYGIE D 08-2097040-4 1080.00 10.00 N
0
OPELLA EMELIO A 08-0430051-1 1320.00 10. 00 N
0
ORCAS I TAS PETER JOHN II L 08-2449446-5 1020.00 10.00 N
0
ORELI,ANO .JULIUS M 06-2462747 -4 1200.00 10.00 N
0
ORINA JOCELYN Q 3 3-202 650 5- 6 2100.00 30.00 N
0
ORlNAY JOVY ELNA o 08-0925117-3 2400.00 30.00 N
0
PAGARAN MARIA KRISTINA B 08 -17 6 950 6-4 2400.00 30.00 N
0
PAQUIBOT IGNACIA MARIA R 34-'7 428'105-8 1500.00 10.00 N
0
PASICARAN S I ENNA ,l 08-2539368-8 1800.00 30.00 N
0
PASQUITO REYNA MAE M 08-2925401-1 2040.00 30.00 N
0
PO MARIE CIIAN G 08-1982 559- 9 2400.00 30.00 N
0
POGOY CARMEN E 08-1042485-0 1380.00 10.00 N
0
PONTIMAYOR FRANKLIN III T 08-18s0134-8 2280.00 30.00 N
0
QU I ROG AGNES AIICAR c 08 -252 918 9-0 2400.00 30.00 N
0
RAMOS OSEPH 08-2-t208Ll-L 1140.00 10.00 N
0
REPEL CRISTINA M 08- 13? 97 03-4 2400.00 30. 00 N
0
REQUIRON RUBlELYN A 08- 17 0238 3- 0 1200.00 10.00 N
0
RESMA JUNETTE R 0I -17 0318 9- 3 2400.00 30.00 N
0
REYES IRENE E 08-0935217-9 1260.00 10.00 N
0
RIVERA ROXANNE D 08-2506666-9 2400.00 30.00 N
0
ROSERO ABE JR. M 08-1331.991-7 2400.00 30.00 N
0
SABAL DANA JIMMY RAE s 08-2788037-7 2400.00 30.00 N
0
SABAN PAN MARITYN A 08-043047?-9 2040.00 30.00 N
0
SALUD VINCENT B 08-1005371-3 2280.00 30.00 N
0
SA],VAffA JAY P 08-1548927 -2 1140.00 10.00 N
0
SARAGA R]CHARD O 08-2396420-0 1260.00 10.00
0
SARAMOSTNG FEDEI,ITO G 0B-1868950-3 1200.00 10.00
0
S ICAT MYRA A 08-1033550-9 2400.00 30. 00
0
SUBRADO JHIZA ANDREA L 34-8345211-7 2040.00 30. 00
0
SUMALINOG ANASTACIO M 08-1502968-7 1140.00 10.00
0
SUMILE GREENLIE L 08-2822890-9 1680.00 10.00
0
TABAMO ROI]L J 08-2408959-5 1140.00 10.00
0
TABlQUE CARESSA TANIA S 09-293997 4-0 2400.00 30.00
0
TABURNO LYNNE A 08-1810110-4 2400.00 30.00
0
TANANDATO DAL]DIG JUNE JR N 08-2980491-1 1680 .00 10.00
0
TANCONGCO ZIPHORA S o8-),992948-2 2400.00 30. 00
0
TAPIAHAN JOEL M 08-1723300-2 1140.00 10.00
0
TANAJURA ELSA A 08-0689439-7 2400.00 30.00
0
TINGNE MIKE J 08-2443822-1 2400.00 30.00
0
tRIMlDAL GRACE A 08-1746443-1 2280 .00 30.00
0
TURTOSA LUCY D a8-208'7 254- 4 1800.00 30.00
0
TY QUEENIE GBACE A 34 - 664 98 3 s-0 2400.00 30 .00
0
UMANDAP JESSII,A A 08-1824150-t 2280 . O0 30. 00
0
VALDON ANDREW C 03-9439980-9 1380.00 10.00
0
VAI,LECERA SHEIRA D 08-14 637 4 6-5 1980.00 30.00
0
VEGA NORAINE JUNE 08-2755584-8 2160.00 30.00
0
VIDAD ROLIBERT B 08-1302121-6 L260.00 10.00
0
VILLARIN JESSEL GRACE B 08-1886658-8 780.00 10.00
0
VIODOR KEVIN JAY G 08-2501517-3 1920.00 30.00
0
YABO CHARIZA E o8-25089'7 2-'t 2160.00 30.00
0
YBIAS MARICEL R 08-2772343-2 1140.00 10.00
0
YEBAN DULCE D 08-1583?48-4 2400.00 30.00
0
YEE MARK ANTHONY G 08-L632543-2 2400.00 30.00
0
ZABAIA MARLYN L 08 -2 08 9s 60-2 1620.00 10.00
0
ZABALA MARVIN A oB-1422290-6 1200.00 10.00
0
Total Number of Employees: 180