First Name SHEILA

Last Name FAJARDO

Account Number X36006521639
Client Number 9023414327
Invoice Date 06 NOV 2013

MEDICAL SERVICES PLAN INVOICE

Balance from previous invoice $ 0.00
You can now pay by credit card at
https://www.revenueservicesbc.gov.
Current Charges bc.ca/pn

DATE ITEM DESCRIPTION DUE For services online go to:

https://www.bceid.ca/register

06 NOV 2013 Medical Services Plan Premiums 66.50 If paying by cheque, send to: PO Box
9085 STN Prov Govt, Victoria BC
Coverage: December 2013 V8W 9E4
Total Charges $ 66.50
The applicable premium must be paid
by the last day of the month (due
Total Due $66.50 date) as per the Medical and Health
PAYMENT DATE by 26 NOV 2013 Care Services Regulation (Section 8).

You may make advance payments on your account. Based on your current
premiums, you can make the following payments for:

3 Months 6 Months 12 Months

$199.50 $399.00 $798.00

Person(s) Covered

SHEILA M FAJARDO

**Paying by the payment date will allow for processing time and ensure the payment is applied to your account by the due date.

RSBC 148 Rev.2013/10/17

Please keep the top portion of invoice for your records and return the bottom portion with your payment Page 1/ 1
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Medical Services Plan of British Columbia RSBC Copy
Payable at most Canadian Financial Institutions
Account Number Overdue Balance Current Charges Total Amount Due Amount Payable Amount Paid

X36006521639 66.50 66.50 66.50

Make cheque or money order payable to the "Minister

of Finance".
360065216390030919610

SHEILA MARIE FAJARDO

301-4338 COMMERCIAL ST Do not write or stamp on face of bill
VANCOUVER BC V5N 4G6 ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯

0012177296036006521639000000665000000066501484

000261272154 01484=900 96