DATE

To Whom It May Concern: This is to certify that NAME is a Philhealth member with MID number ________________. This further certifies that she has the following contributions to wit: MONTH

OR NO. OR# OR# OR# OR# OR# OR# OR# OR#

DATE OF PAYMENT -

January 2013 February 2013 March 2013 April 2013 May 2013 June 2013 July 2013 August 2013

This certification is issued upon the request of Ms. Pachecoand valid for whatever legal purposes it may serve. Done this 3rdday of October 20__ at NAME COMPANY, Makati City.

Signed by:

NAME Authorized Signatory