Employer ID # 01-402000147-6 ( KASAMBAHAY ) Tel # 2143825

Employer Name LOUIE RICHIE ONG

Address BAGONG SILANG, BALANGASAN DIST., PAGADIAN CITY

NO. OF NAME
EXTENSION MIDDLE NAME BIRTH DATE
PHILHEALTH # LAST NAME FIRST NAME PERIOD COVERED MONTHLY SALARY EE SHARE
EMPLOYEES

14-225000761-1 2 JIMENO MARY ANN OBEREZ 4/29/1998 NOV, 2018 5,000.00 137.50
14-225000764-6 3 TUTOY JOAN ROXAS 2/27/1990 NOV, 2018 5,000.00 137.50
4 xxxx nothing follows xxxx
5
6
7
8
9
10
11
12

Total Remittance 275.00

TOTAL PAYMENT: 550.00

Prepared by: Approved by:

HEAD OF OFFICE OR AUTHORIZED REPRES

Signature Over Printed Name
ER SHARE REMARKS

137.50
137.50

275.00
Employer ID # 01-402000147-6 ( KASAMBAHAY ) Tel # 2143825
Employer Name LOUIE RICHIE ONG
Address BAGONG SILANG, BALANGASAN DIST., PAGADIAN CITY

NO. OF NAME
EXTENSION MIDDLE NAME BIRTH DATE
PHILHEALTH # LAST NAME FIRST NAME PERIOD COVERED MONTHLY SALARY EE SHARE
EMPLOYEES

14-225000761-1 2 JIMENO MARY ANN OBEREZ 4/29/1998 OCT, 2018 5,000.00 137.50
14-225000764-6 3 TUTOY JOAN ROXAS 2/27/1990 OCT, 2018 5,000.00 137.50
4
5 xxxx nothing follows xxxx
6
7
8
9
10
11
12

Total Remittance 275.00

TOTAL PAYMENT: 550.00

Prepared by: Approved by:

HEAD OF OFFICE OR AUTHORIZED REPRES

Signature Over Printed Name
ER SHARE REMARKS

137.50
137.50

275.00
Employer ID # 01-402000147-6 ( KASAMBAHAY ) Tel # 2143825
Employer Name LOUIE RICHIE ONG
Address BAGONG SILANG, BALANGASAN DIST., PAGADIAN CITY

NO. OF NAME
EXTENSION MIDDLE NAME BIRTH DATE
PHILHEALTH # LAST NAME FIRST NAME PERIOD COVERED MONTHLY SALARY EE SHARE
EMPLOYEES

14-225000761-1 2 JIMENO MARY ANN OBEREZ 4/29/1998 SEPT, 2018 5,000.00 137.50
03-025663513-1 3 SUMINGUIT ALMIE ARNAIZ 2/25/1996 SEPT, 2018 5,000.00 137.50
14-225000764-6 4 TUTOY JOAN ROXAS 2/27/1990 SEPT, 2018 5,000.00 137.50
5
6 xxxx nothing follows xxxx
7
8
9
10
11
12

Total Remittance 412.50

TOTAL PAYMENT: 825.00

Prepared by: Approved by:

HEAD OF OFFICE OR AUTHORIZED REPRES

Signature Over Printed Name
ER SHARE REMARKS

137.50
137.50 NH
137.50

412.50
Employer ID # 01-402000147-6 ( KASAMBAHAY ) Tel # 2143825
Employer Name LOUIE RICHIE ONG
Address BAGONG SILANG, BALANGASAN DIST., PAGADIAN CITY

NO. OF NAME
EXTENSION MIDDLE NAME BIRTH DATE
PHILHEALTH # LAST NAME FIRST NAME PERIOD COVERED MONTHLY SALARY EE SHARE
EMPLOYEES

14-225000761-1 2 JIMENO MARY ANN OBEREZ 4/29/1998 NOV, 2018 5,000.00 137.50
03-025663513-1 3 SUMINGUIT ALMIE ARNAIZ 2/25/1996 NOV, 2018 5,000.00 137.50
14-225000764-6 4 TUTOY JOAN ROXAS 2/27/1990 NOV, 2018 5,000.00 137.50
5
6 xxxx nothing follows xxxx
7
8
9
10
11
12

Total Remittance 412.50

TOTAL PAYMENT: 825.00

Prepared by: Approved by:

HEAD OF OFFICE OR AUTHORIZED REPRES

Signature Over Printed Name
ER SHARE REMARKS

137.50
137.50 NH
137.50

412.50
Employer ID # 01-402000147-6 ( KASAMBAHAY ) Tel # 2143825
Employer Name LOUIE RICHIE ONG
Address BAGONG SILANG, BALANGASAN DIST., PAGADIAN CITY

NO. OF NAME
PHILHEALTH # LAST NAME FIRST NAME MIDDLE NAME BIRTH DATE PERIOD COVERED MONTHLY SALARY EE SHARE ER SHARE REMARKS
EMPLOYEES EXTENSION

14-225000761-1 1 JIMENO MARY ANN OBEREZ 4/29/1998 MARCH, 2018 5,000.00 137.50 137.50
14-225000763-8 2 LOMOLJO BIMELYN MAGNONOT 8/11/1990 MARCH, 2018 5,000.00 137.50 137.50
14-225000764-6 3 TUTOY JOAN ROXAS 2/27/1990 MARCH, 2018 5,000.00 137.50 137.50
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Total Remittance 412.50 412.50

TOTAL PAYMENT: 825.00

Prepared by: Approved by:

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE

Signature Over Printed Name
Employer ID # 01-402000147-6 ( KASAMBAHAY ) Tel # 2143825
Employer Name LOUIE RICHIE ONG
Address BAGONG SILANG, BALANGASAN DIST., PAGADIAN CITY

NO. OF NAME
PHILHEALTH # LAST NAME FIRST NAME MIDDLE NAME BIRTH DATE PERIOD COVERED MONTHLY SALARY EE SHARE ER SHARE REMARKS
EMPLOYEES EXTENSION

14-225000761-1 1 JIMENO MARY ANN OBEREZ 4/29/1998 FEBRUARY, 2018 5,000.00 137.50 137.50
14-225000763-8 2 LOMOLJO BIMELYN MAGNONOT 8/11/1990 FEBRUARY, 2018 5,000.00 137.50 137.50
14-225000764-6 3 TUTOY JOAN ROXAS 2/27/1990 FEBRUARY, 2018 5,000.00 137.50 137.50
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Total Remittance 412.50 412.50

TOTAL PAYMENT: 825.00

Prepared by: Approved by:

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE

Signature Over Printed Name
Employer ID # 01-402000147-6 ( KASAMBAHAY ) Tel # 2143825
Employer Name LOUIE RICHIE ONG
Address BAGONG SILANG, BALANGASAN DIST., PAGADIAN CITY

NO. OF NAME
PHILHEALTH # LAST NAME FIRST NAME MIDDLE NAME BIRTH DATE PERIOD COVERED MONTHLY SALARY EE SHARE ER SHARE REMARKS
EMPLOYEES EXTENSION

14-225000761-1 1 JIMENO MARY ANN OBEREZ 4/29/1998 JANUARY, 2018 5,000.00 137.50 137.50
14-225000763-8 2 LOMOLJO BIMELYN MAGNONOT 8/11/1990 JANUARY, 2018 5,000.00 137.50 137.50
14-225000764-6 3 TUTOY JOAN ROXAS 2/27/1990 JANUARY, 2018 5,000.00 137.50 137.50
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Total Remittance 412.50 412.50

TOTAL PAYMENT: 825.00

Prepared by: Approved by:

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE

Signature Over Printed Name