Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

www.philhealth.gov.ph

Date/Time Generated : 05/21/2024 12:04:41

SPA No : SPA100038738831
Applicable Period : 04-2024
Report Type : Regular
EMPLOYEES PREMIUM REMITTANCE LIST
PhilHealth Number : 018000013650
Employer Name : MAMA CELIA'S FOOD HOUSE
Employer Address : MAGALLANES AGUSAN DEL NORTE
Employer TIN : null
Employer Type : Private
No. PhilHealth No. Surname Given Name Middle Name PS ES Status | Remarks
1 182523972503 ABALLE CHRISTIAN HONGHONG 0.00 0.00 S 2024-03-31 00:00:00

2 182008060569 ABAMONGA MONALIZA ALFARO 250.00 250.00 A

3 180500973097 CUBILLAS REY JAY MILLANES 250.00 250.00 A

4 182502937694 ESCOL JOSHUA YURAG 250.00 250.00 A

5 030261881736 GASPAN RUBY CREADO 500.00 500.00 A

6 182008151416 MARAYA LOWY MECA 250.00 250.00 A

7 180500132025 VENTURA JR ANTONIO LUCAS 500.00 500.00 A

8 180500889061 VENTURA LIZA CAILING 500.00 500.00 A

Subtotal 2,500.00 2,500.00

GRAND TOTAL 5,000.00

Prepared by : Certified True and Correct by :

Signature over Printed Name and Designation Signature over Printed Name and Designation