Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre Building, 709 Shaw Boulevard, Pasig City
Healthline: 441-7444 Website: www.philhealth.gov.ph

STATEMENT OF PREMIUM ACCOUNT (SPA) - FORMAL SECTOR

Date generated : May 14, 2024
PEN: 201213300166
Employer Type : PRIVATE SPA100038673087
Business/Agency Name : GLENN DICK C AYALA/CUDAL PRESS

Group Name :

CURRENT CHARGES :
Applicable Month : May 2024
No. of Employees : 3
Report Type : Regular
Amount of Premium:
Employee Share : 825.00
Employer Share : 825.00

Premium Due for the Current Applicable Period 1,650.00

Due Date:
TOTAL AMOUNT DUE 1,650.00 On or Before 20 June
2024

IMPORTANT REMINDER
Per available records, it appears that your account has deficiencies as follows:

Reference Deficiency Applicable Month/s Amount

SPA100006828115 No Premium payment Jan 2016 1,000.93
SPA100011195329 No Premium payment Apr 2017 800.00
SPA100035640893 No Premium payment Jul 2019 825.00
SPA100035640896 No Premium payment Aug 2020 900.00
SPA100035640879 No Premium payment Aug 2021 900.00

Please settle the above deficiencies immediately as indicated. All reports must be posted within five (5) days after payment.
For assistance, coordinate with the PAIMS assigned to your account or visit the nearest PhilHealth Office. Thank you.

Date generated : May 14, 2024

PEN: 201213300166
Employer Type : PRIVATE SPA100038673087
Business/Agency Name : GLENN DICK C AYALA/CUDAL PRESS

Group Name :

CURRENT CHARGES :
Applicable Month : May 2024
No. of Employees : 3
Report Type : Regular
Amount of Premium:
Employee Share : 825.00
Employer Share : 825.00

Premium Due for the Current Applicable Period 1,650.00

Due Date:
TOTAL AMOUNT DUE 1,650.00 On or Before 20 June
2024