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STATEMENT OF ACCOUNT

NORMA VIÑA'S MATERNITY LYING INN CLINIC - DASMARIÑAS


126 BUCAL SAMAPLOC 2 DASMARIÑAS, CAVITE

ACCOUNT INFORMATION BILLING INFORMATION

Account Number : 0000283 Statement Date : October 31, 2018


HCI Code : M41007887 Due Date : Payable 3 calendar day(s) from receipt of billing
SOA Number : 20180011685 Term/Billing Cycle : Semi-monthly
TIN : 190-492-887-000 Service Fee per Claim : ₱ 10.00
Business Style :

STATEMENT SUMMARY
Period Covered : Oct 16, 2018 - Oct 31, 2018

Total Claims 5 ₱ 50.00


Total Free Claims (1) (₱ 10.00)

4 ₱ 40.00

Vatable Sales ₱ 35.71


Value Added Tax (12%) ₱ 4.29
Total Amount ₱ 40.00

Overdue/Balance from previous billing/s ₱ 130.00


Current Amount Due ₱ 40.00

Total Amount Paid (₱ 0.00)

Total Amount Due (Inclusive of VAT) : ₱ 170.00

Please make all cheque payments payable to EUROLINK NETWORK INTERNATIONAL CORP. and kindly deposit any mode of
payment (cash or cheque) to the following bank accounts:

* Union Bank Account No. 000590016428


* Banco De Oro Account No. 003430017615
* Bank of the Philippines Islands Savings Account No. 004013030524

Note: To properly account your payment, please notify us by sending a scanned copy of the validated deposit slip and
indicate your Facility Name with corresponding Philhealth Accreditation Number (PAN) at eurolink@euroempire.com.

Telephone: (+632) 687 9999


Unit 2101 Tektite East Tower, Philippine Stock Exchange Center, Exchange Road, Ortigas, Pasig City, Philippines, Philippines 1605 Telephone: (+632) 661 4797
Website:
Fax: (+632) 687 5020
Unit 1605 Tektite West Tower, Philippine Stock Exchange Center, Exchange Road, Ortigas, Pasig City, Philippines, Philippines 1605 www.easyclaimsph.com