HQP-TMF-191

(V04, 12/2020)
Pag-IBIG Fund

PAYMENT INSTRUCTION FORM (PIF)

______________________
IMUS

Employer ID Number : 210301860001

Payment Instruction Date : September 11, 2023
7232 54EF B162
Payment Instruction Number (PIN)

EMPLOYER/BUSINESS NAME : KIDNEYLAB CORP

ADDRESS AND CONTACT DETAILS

Unit/Room No., Floor Building Name Lot No., Block No. AREA CODE TELEPHONE NUMBER
Business (Direct Line)
Phase No. House No. Street Name
CABEZAS COR AVENIDA RIZAL ST Business (Trunk Line) Local
Subdivision Barangay Municipality
Cell Phone Number
BAHAYANG PAG-ASA MOLINO V BACOOR
09178833090
SUBD
Province Region Zip Code
Business Email Address
CAVITE REGION 4-A (CALABARZON) 4102 kidneylabcorporation@gmail.com

PERIOD COVERED
TYPE OF PAYMENT AMOUNT DUE CLIENT PRINT VALIDATION
From To
MEMBER SAVINGS 08 - 2023 08 - 2023 1,400.00

MULTI-PURPOSE LOAN 08 - 2023 08 - 2023 1,667.87

TOTAL AMOUNT 3,067.87

Prepared by: Date:
ROGELIO MIRANDA
ACCOUNTANT
______________________________ 09/11/2023
____________

REMINDERS:
09/11/2023
1. This form is valid from ______________ 10/10/2023
to ______________. If payment to be made is beyond the reflected validity period, this form will not be accepted
by any accredited collecting partner/s.
2. Please remit MS/pay loan obligation on or before the due date to avoid incurring penalties.

Employer ID Number 210301860001

Total Amount Due Php 3,067.87

PIN: 723254EFB162 TO BE FILLED OUT BY THE PAYOR

KIDNEYLAB CORP Cash Payment

CABEZAS COR AVENIDA RIZAL ST, BAHAYANG PAG-ASA SUBD, MOLINO Check Payment
V, BACOOR, CAVITE, 4102 Check No.
Bank/Branch