Cash Advance

Employee Name: Aleth Nicola C. Cuadra Employee level: Non Management Date Requested: 16-Aug-21

Department: Finance Travel Period: NA Date Needed: 20-Aug-21

Purpose: Cash Advance for Philippine Health Insurance Contribution for the month of June 2021

(Pls fill-in specific date)

Type of Expenses For Finance Use Only

Depart Date Return Date Date Received by Finance:

Per Diem Qty. Rate Amount Outstanding Cash Advances Amount Date Issued Remarks

Breakfast - - Per Diem

Lunch 2 - - Representation

Dinner - - Hotel Accommodation

Overnight - - Transportation
0
# of pax Budget per Pax Gasoline

Representation - Repairs & Maintenance

Company Trainings and Seminar

Customer's Name(s) Others

Purpose of Representation Total

# of Nights Budget/ night

Hotel Accommodation - - Remarks from Accounts Payable:
Transportation
Gasoline
Repairs & Maintenance
Trainings/Seminar
X Others CA for PHIC Contribution 072021 37,505.25

TOTAL 37,505.25

Authority to Deduct

I promise to liquidate with valid receipts and return the excess amount within 15 days upon cash advance utilization. Otherwise, I hereby authorize Finance Department and
HRA Department to deduct outstanding and unliquidated cash advances from my payroll account

Aleth Nicola C. Cuadra 8/16/21 12:37 PM

Employee Name and Signature Date and Time

APPROVER:

Department Manager Division Manager President

John Rex C. Millora Eva Preciousa P. Aquino ___________________________

Signature & Date Signature & Date Signature & Date
 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 : July 28, 2021
PEN: 008030011259
Employer Type : PRIVATE SPA100026180332
Business/Agency Name : SUHAY OPC

Group Name :

CURRENT CHARGES :
Applicable Month : July 2021
No. of Employees : 30

Amount of Premium:
Employee Share : 18,752.62
Employer Share : 18,752.63

Premium Due for the Current Applicable Period 37,505.25

Due Date:
TOTAL AMOUNT DUE 37,505.25 Please Pay Immediately

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

Reference Deficiency Applicable Month/s Amount

SPA100021255213 No Premium payment Oct 2019 17,778.75
SPA100022870012 No Premium payment Aug 2020 33,069.75
SPA100023296466 No Premium payment Oct 2020 33,069.75
SPA100025550137 No Premium payment May 2021 38,538.75
SPA100026001482 No Premium payment Jun 2021 42,340.68

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 : July 28, 2021

PEN: 008030011259
Employer Type : PRIVATE SPA100026180332
Business/Agency Name : SUHAY OPC

Group Name :

CURRENT CHARGES :
Applicable Month : July 2021
No. of Employees : 30

Amount of Premium:
Employee Share : 18,752.62
Employer Share : 18,752.63

Premium Due for the Current Applicable Period 37,505.25

Due Date:
TOTAL AMOUNT DUE 37,505.25 Please Pay Immediately