Professional Documents
Culture Documents
ORDER OF PAYMENT
NAME: ________________________________________________________________________________________________________________________________________
DORONIO, JAPHET DELA CERNA
NURSE 000778
NAME OF BOARD EXAM TAKEN: ______________________________________ APPLICATION NO: ______________________________________________
Official Receipt No: _____________________
E2023-03-04431202 Date: ______________________________________
03/14/2023 Requested by: ____________________________
Received by: _____________________________ Due Date/Time: __________________________
CLAIM SLIP
APPOINTMENT DATE: March 22, 2023 (01:00 PM TO 02:00 PM) - Robinsons Place Tagum
REFERENCE NO: CE015X5TUYLA | OR: E2023-03-04431202 | AMOUNT: PHP 75.00
PROFESSION: ______________________________________
NURSE DATE OF EXAM: ____________________________________________
-
ARD-01
Rev.01
November 3, 2017
Page 1 of 2