Maxicare Healthcare Corporation

Maxicare Tower 203 Salcedo Street Brgy. San Lorenzo

Legaspi Village Makati City 1229
VAT REG. TIN 000-487-637-00000

BILLING INVOICE
Invoice Date: October 01, 2021 PAYMENT DUE DATES

URIEL BERNADAS Invoice Number 1000541546

ONLINE SELLER
Payment Reference Number 10005415467
9700355383 - URIEL BERNADAS Total Amount Due on
L7 BLK E, LAVANDER ST. FILIPINAS FARM BRGY. IRUHIN WEST November 16, 2021 PHP 6,713.00
TAGAYTAY CAVITE 4120
BUS. STYLE: N/A Mode of Payment Quarterly
DIRECT Coverage Period February 16, 2021 - February 15, 2022

Please remit to Maxicare Healthcare Corporation the amount of ***SIX THOUSAND SEVEN HUNDRED THIRTEEN PESOS ONLY*** (PHP 6,713.00) in payment of
the following:

BILLING INVOICE
Billing Period Covering: November 16, 2021 - February 15, 2022
Accounting Document Transaction Type Amount
8100183438 Bill Premium 6,713.00
VAT Sales 5,993.75
VAT Exempt Sales -
Zero Rated Sales -
VAT Amount 719.25
Total Sales 6,713.00
Total Amount Due for Non withholding Tax Agent PHP 6,713.00
Less: Withholding Tax, if Withholding Agent (ATC Code: ) -
TOTAL AMOUNT DUE For Withholding Tax Agent PHP 6,713.00

Please settle your account on or before November 16, 2021 to ensure continuity of coverage. Further, please notify us immediately of any billing error in the Billing
Invoice (BI). If no error is reported within fifteen calendar (15) days from Invoice Date, the Billing Invoice shall be considered final and accurate.

Important Reminders:
1. Any transactions made after the generation of this Billing Invoice will be reflected in your subsequent billing statements.
2. To all withholding agents: Submit corresponding certificate of tax withheld (BIR Form No. 2307) to Maxicare upon remittance of payment. Failure to provide CWT
Certificate, the amount will form part of your Outstanding Balance.
3. If your due date falls on a weekend or holiday, please settle on the last working day before due date.
4. Please inform us on any changes on your billing address and/or contact number.
5. Penalty and/or suspension may be charged/implemented in case of delayed or non-payment.
6. Accredited Collection Partners: Equicom Savings Bank (EqB), BPI, Metrobank, PNB, Security Bank, Unionbank, RCBC or BDO (through Bills Payment Facility); CIS
Bayad Center. Payment through our collection partners shall be credited within 3 working days from actual remittance.
*For Suggestions or other inquiries, you can send an email to customerservice@maxicare.com.ph

Accreditation No.:
Date of Accreditation:
Permit To Use (PTU) No.: 1812_0126_PTU_CAS_000418
Date Issued: DECEMBER 28, 2018 Valid Until: DECEMBER 31, 2023
Form No.: 1000000001 - 1999999999

THIS DOCUMENT IS NOT VALID FOR CLAIM OF INPUT TAX

THIS DOCUMENT SHALL BE VALID FOR FIVE (5) YEARS FROM THE DATE OF THE PERMIT TO USE.

THIS BILLING INVOICE IS A SYSTEM GENERATED FORM.

SIGNATURE IS NOT REQUIRED.
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(KINDLY SURRENDER THIS PORTION TO THE CASHIER DURING PAYMENT)
URIEL BERNADAS
ONLINE SELLER COVERED PERIOD
9700355383 - URIEL BERNADAS
L7 BLK E, LAVANDER ST. FILIPINAS FARM BRGY. IRUHIN WEST February 16, 2021 - February 15, 2022
TAGAYTAY CAVITE 4120
DUE DATE
( ) Check Bank: _____________ Check No.: _________
November 16, 2021
( ) Credit Card Number: ____________________________________

( ) Cash

Amount Paid: _______________________