SRR = SINGA SHIP MANAGEMENT PHILS., INC. = iat dae iz * E IsogaR CERTIFICATION ‘This is to certify that FLEET MARITIME SERVICES INTERNATIONAL. LTD/SINGA SHIP MGT. PHILS., INC. with PHIC No. 00-1030002603 has paid PHILLHEALT PREMUIM in favor of MR. RENANTE P. LABAN with PHILHEALTH No. 19-052180143-7 for the following months. DATE AMOUNT INVOICE NUMBER March 2023 1,507.24 SPA100034253133 April 2023 1,547.00 SPA100034585969 May 2023 1,551.48 SPA100034954955, June 2023 1,535.80 SPA100035279497 July 2023 1,516.20 SPA100035656109 August 2023 1,573.88 SPA100035995859 September 2023 1,575.56 SPA100036279932 October 2023 1,576.96 SPA100036612150 CURRENTLY ONBOARD ~ DATE PAID Apr. 14,2023 May 12,2023 June 14, 2023 July 12, 2023 Aug. 14, 2023 Sept. 13, 2023 Oct. 12, 2023 Nov. 14, 2023 This certification is issued upon the request of MR. LABAN for Philhealth purposes only. Issued this 29" day of NOVEMBER 2023 at Makati City. Centi ITEC NACONIEL C. DELA TORRE President 21/F. BDO Plaza, 8737 Paseo de Roxas, Makati City, 1209 Philippines Tels. (63-2) 8-892-6280 + 8-892-3928 + 8-892-7089 « B-892-5527 + 8-892-2195 + Fax: (63-2) §-892-3977 E-mail: singamnl@singaship.ph « Web Site: www.singaship.phRepu of te Pippin E INE HEALTH INSURANCE CORPORATION F ‘Gaytate Centre 79 Sha oclevad, Pasig Cy PhilHealth CcallCeter 2) 48-7442» Tanne (2) 41-900 CSF Ir Peer el sei ‘mal achancemerepilelth on & (Claim Signature Form) 1.PhilHtealth Identification Number (PIN) of Member: (7 |-(OK IZ) IMAI -Z) 2.Name of Member: = 3.Member Date of Birth: Lhe REwto re : P COCO Coo 4.PhilHealth Identification Number (PIN) of Dependent: co Ceres Oo 5.Name of Patient: 17.Confinement Period: co-ocooo S.CERTIFICATION OF MEMBER: Under the pelt oflow, attest thot the formation | rovded in thi Form are true and accurate to the best of my knowledge 2. Contact No. x E INTEL LIMTER ‘SEO DE ROXAS, MAKATH CITVi41205 3.Business Name: _ 2-804 4. CERTIFERTION OF EMPLOYE? This sto certify thet the equi 8 month premium cgbtribution plus at est 6 months contributions preceding the 3 months qualifying contributions within 22 ive on Por ore consistent wth our veabe records \CONIEL C. DELA TORRE ovesoes OT ag) 2121 meth dy hereby consent tothe submisionand examination o the patents pertinent medal record forthe purpoe of veryng the vero ths claim tect ecient procestng of benef payment ‘hereby hold Piteath ar ny ofits offers, employees and/or representatives re from ony legal abies relative to the hein mentioned canset which have ‘alton an willingly given connection with his claim forrimbursement before Pitialth Restonnootne (sone Jos cmantterttepsens E]sting Jon Reason orsiningon a CGH EID L.PhilHealth Benefits: icosorRvSCode: 3, FisiCnse ‘cert that ences rendered were recardedin the poten chart and health ore institution ecards and tha the ern nformation given are tre and correc, CocoonSLVOITANG NI GAHSTIAWOOOV I OL, AINVN GGLLNDId WIAO AANLWNOIS Siang a0 aova yedis2ad T PIOT WG) INOSUN *TAOMV CALSTT-“ON TVLOL PENNY qreoke b wpe J ayn ad 'nvaer |CCBIOB 1210-41 ma eDhcreg [ea oui | awvis | xoxo sotanasouww — | Sia SSaNGaY TVA T SOeb ALO LWW ‘S¥XOW 30 O58Va Levey ‘Vavia 008 iz ‘seauaaw' £0 92000g O09 “ON WAKO TAWA JRUATT UL ssov.42s IMLLiev 13547 OM'ST WON ats VONRRS SWULA/AAAO TAWA AO TINVN, cla sagas ——a—o . > W4Od SIH.L ONTHSI 1d WOOOY AMOTAS MOVE THL.LV NOLLONULSNI GVaM ASVATd