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In Payment of the following: MAYA BANK, INC.

6/F Launchpad Building, Reliance cor., Sheridan St.


Brgy. Highway Hills Mandaluyong City
Billing Stmt No. Amount
1550 Philippines
Tel.: 511-3421
NON-VAT Reg. TIN: 603-804-170-0000
Total Fees/Interest 254.70
Less: SC/PWD Disc 0.00
OFFICIAL RECEIPT NO.: 1003887958
Total Due 254.70
Less: Withholding Tax 0.00 Customer's Copy
Date: 01/12/2024
Amount Due 254.70
Received from Riza Joy Andal TIN
Bus. Style/Name Address at

the sum of TWO HUNDRED FIFTY-FOUR


AND 70/100 PESOS ONLY (PHP 254.70)
In full /partial payment for 69100094-618780100987

CASH CHECK MAYA OTHERS MAYA BANK, INC.


Check No.: ________________________
Bank: ________________________ System Generated
_________________________________
BIR Acknowledgement Certificate Number: AC-041-032022-000016
Cashier / Authorized Representative
Date Issued: 05/27/2022
Series Range: 1000000001 - 1999999999

"THIS DOCUMENT IS NOT VALID FOR CLAIM OF INPUT TAXES"

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