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 : April 09, 2022
PEN: 003000050882
Employer Type : PRIVATE SPA100028800702
Business/Agency Name : Broadtek Media Co.

Group Name :

CURRENT CHARGES :
Applicable Month : March 2022
No. of Employees : 5

Amount of Premium:
Employee Share : 1,275.00
Employer Share : 1,275.00

Premium Due for the Current Applicable Period 2,550.00

Add: Interests and/or Surcharges Incurred for the Previous 57.15

Applicable Month SPA Number Amount Date of Payment PAR/POR No. Interest
Dec 2021 SPA100028493882 322.17 03/22/2022 YPHM32200000324 29.88
Jan 2022 SPA100028516590 300.00 03/22/2022 YPHM32200000320 18.27
Feb 2022 SPA100028516626 300.00 03/22/2022 YPHM32200000316 9.00

Due Date:
TOTAL AMOUNT DUE 2,607.15 Please Pay Immediately

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

Reference Deficiency Applicable Month/s Amount

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 : April 09, 2022

PEN: 003000050882
Employer Type : PRIVATE SPA100028800702
Business/Agency Name : Broadtek Media Co.

Group Name :

CURRENT CHARGES :
Applicable Month : March 2022
No. of Employees : 5

Amount of Premium:
Employee Share : 1,275.00
Employer Share : 1,275.00

Premium Due for the Current Applicable Period 2,550.00

Add: Interests and/or Surcharges Incurred for the Previous 57.15

Applicable Month SPA Number Amount Date of Payment PAR/POR No. Interest
Dec 2021 SPA100028493882 322.17 03/22/2022 YPHM32200000324 29.88
Jan 2022 SPA100028516590 300.00 03/22/2022 YPHM32200000320 18.27
Feb 2022 SPA100028516626 300.00 03/22/2022 YPHM32200000316 9.00

Due Date:
TOTAL AMOUNT DUE 2,607.15 Please Pay Immediately