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 : March 09, 2020
PEN: 003000050278
Employer Type : PRIVATE SPA100021132948
Business/Agency Name : FMT CARGO EXPRESS

Group Name :

CURRENT CHARGES :
Applicable Month : February 2020
No. of Employees : 14

Amount of Premium:
Employee Share : 2,745.60
Employer Share : 2,745.60

Premium Due for the Current Applicable Period 5,491.20

Due Date:
TOTAL AMOUNT DUE 5,491.20 Please Pay Immediately

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

Reference Deficiency Applicable Month/s Amount

SPA100015243979 No Premium payment Sep 2018 5,491.20
SPA100018738560 No Premium payment Mar 2019 9,292.80
SPA100018722485 No Premium payment Apr 2019 8,706.46
SPA100018723587 No Premium payment May 2019 10,137.60
SPA100018726447 No Premium payment Jul 2019 7,180.80
SPA100019112891 No Premium payment Aug 2019 7,147.86
SPA100019768478 No Premium payment Sep 2019 4,922.50
SPA100020022476 No Premium payment Nov 2019 5,445.00
SPA100020293245 No Premium payment Dec 2019 5,417.50
SPA100020774882 No Premium payment Jan 2020 6,218.90
No SPA generated Oct 2019

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 : March 09, 2020

PEN: 003000050278
Employer Type : PRIVATE SPA100021132948
Business/Agency Name : FMT CARGO EXPRESS

Group Name :

CURRENT CHARGES :
Applicable Month : February 2020
No. of Employees : 14

Amount of Premium:
Employee Share : 2,745.60
Employer Share : 2,745.60

Premium Due for the Current Applicable Period 5,491.20

Due Date:
TOTAL AMOUNT DUE 5,491.20 Please Pay Immediately