OFFICIAL RECEIPT

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BPI-PHILAM LIFE ASSURANCE COMPANY OR No. HO01911579
BPI-PHILAM LIFE 6811 Ayala Avenue, Bel-Air Makati City
VAT REG. TIN 000-318-213-000

BUSINESS STYLE: BPI-PHILAM LIFE ASSURANCE COMPANY

Received From: EDITHA D FERNANDEZ RECEIPT DATE: 16/11/2021 15:36:12
EDITHA D FERNANDEZ PAYMENT FOR REF NO. 7010585765
SAGUD BAHLEY EFF. DATE: PD TO DATE:
SAN FABIAN
PANGASINAN 2433
Agent Code: 088440346
TIN: BUSINESS STYLE
AMOUNT
VATable Sales 0.00
Zero-rated Sales 0.00
VAT-Exempt Sales
Deposit on Application 6,999.93

TOTAL 6,999.93 PHP

ACK Cert No. AC_125_082020_000006 Particulars/Payment Form: CM/BANK/TPA REMIT

Inclusive Series: HO00000001 to HO99999999 BR1 (Csh) 16/11/2021 6,999.93
Effectivity Date: 01/11/2020 Issue Date: 26/08/2020 System Generated. No Signature required.
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| Terms and Conditions |
| 1. This receipt shall not be binding upon the Company for any part of paid payment covered by check or any form of remittance other than cash unless such remittance is promptly honoured on presentment of payment |
| 2. This receipt shall produce legal effects only if the payment is in cash or is otherwise duly validated and/or credited to a Company bank account |
| 3. If this payment is not acceptable for the purpose it is offered. It will be returned in the normal course of business |
| 4. No person except an executive officer of the Company is authorized to make after or discharge contracts or waive forfeitures. |
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