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

PEN : 001010004593 SPA No. : SPA100007762773

Employer Type : Private Date Generated : Dec 08, 2016
Business/Agency Name : W N H ENTERPRISES
Premium Due Date:
Group Account Name: Please Pay Immediately

CURRENT CHARGES:
Applicable Month : November 2016
No. of Employees : 2
Amount of Premium:
Employee Share 100.00
Employer Share 100.00
Premium Due for the Current Applicable Period 200.00
TOTAL AMOUNT DUE 200.00

IMPORTANT REMINDER:
Per available records, it appears that you may have missed paying and/or reporting your payments for the following applicable
period/s:
SPA Number Applicable Month/s Premium/Report Due
SPA100007762770 Oct 2016 400.00
Jun 2015
Jul 2015
Aug 2015
Sep 2015
Oct 2015
Nov 2015
Dec 2015
Jan 2016
Feb 2016
Mar 2016
Apr 2016
May 2016
Jun 2016
Jul 2016
Aug 2016
Sep 2016

Please settle the above accounts immediately and coordinate with your PAIMS (or visit the nearest PhilHealth Office) to assist
you in posting these payments. Thank you.

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PHILHEALTH EPRS PREMIUM PAYMENT SLIP

Remittance Due Date : Please Pay Immediately SPA No. : SPA100007762773
Date Generated : Dec 08, 2016
PEN : 001010004593 Employer Type : Private
Business/Agency Name : W N H ENTERPRISES
Applicable Month : November 2016 No. of Employees : 2

Principal Grouping No:

Principal Name:

Amount of Premium:
Employee Share 100.00
Employer Share 100.00
Premium Due for the Current Applicable Period 200.00
TOTAL AMOUNT DUE 200.00