COMPANY NAME : CARGEM MANAGEMENT CORPORATION

COMPANY ADD : NO. 12 UNITED ST. COR. FIRST ST. BO. KAPITOLYO PASIG CITY
SSS NO. : 03-8690750-0
DECEMBER 2019
EMPLOYEES SSS CONTRIBUTION 2019

NAME : EMPLOYEE SHARE EMPLOYER SHARE EC/ER TOTAL

1 Antolin,Emelita 760.00 1,520.00 30.00 2,310.00
2 Araza, Gerry 800.00 1,600.00 30.00 2,430.00
3 Baluran,Jaysan 680.00 1,360.00 30.00 2,070.00
4 Buhia,Genalyn 320.00 640.00 10.00 970.00
5 Cadiz, Edward 800.00 1,600.00 30.00 2,430.00
6 Cadiz, Michael 800.00 1,600.00 30.00 2,430.00
7 Calilan, Crisanto 600.00 1,200.00 30.00 1,830.00
8 Caudilla, Cristen 800.00 1,600.00 30.00 2,430.00
9 Coronado,Michael 600.00 1,200.00 30.00 1,830.00
10 Dolor, Ivy 800.00 1,600.00 30.00 2,430.00
11 Gelacio, Geraldine 640.00 1,280.00 30.00 1,950.00
12 Homo,Edison 560.00 1,120.00 10.00 1,690.00
13 Indong,Edgardo 680.00 1,360.00 30.00 2,070.00
14 Mangilit, Ronald 800.00 1,600.00 30.00 2,430.00
15 Quebral,Leo 600.00 1,200.00 30.00 1,830.00
16 Ramos, Cleotilde 800.00 1,600.00 30.00 2,430.00
17 Solloso,Jose Emmanuel 560.00 1,120.00 10.00 1,690.00
18 Ulanday, Eddie 800.00 1,600.00 30.00 2,430.00
19 Yamson,Geraldine 600.00 1,200.00 30.00 1,830.00

Total Amount 13,000.00 26,000.00 510.00 39,510.00

 PHILIPPINE HEALTH INSURANCE CORP.

COMPANY NAME : CARGEM MANAGEMENT CORPORATION

COMPANY ADD : No. 12 UNITED ST. COR. FIRST ST. BO. KAPITOLYO PASIG CITY
PHILHEALTH No. : 2003-7430-1429
DECEMBER 2019
EMPLOYEES NAME : EMPLOYEES SHARE EMPLOYER SHARE TOTAL
1 Antolin,Emelita 261.25 261.25 522.50
2 Araza, Gerry 275.00 275.00 550.00
3 Baluran,Jaysan 233.75 233.75 467.50
4 Buhia,Genalyn 137.50 137.50 275.00
5 Cadiz, Edward 275.00 275.00 550.00
6 Cadiz, Michael 275.00 275.00 550.00
7 Calilan, Crisanto 206.25 206.25 412.50
8 Caudilla, Cristen Joy 275.00 275.00 550.00
9 Coronado,Michael 206.25 206.25 412.50
10 Dolor, Ivy 330.00 330.00 660.00
11 Gelacio, Geraldine 220.00 220.00 440.00
12 Homo,Edison 191.98 191.98 383.96
13 Indong,Edgardo 233.75 233.75 467.50
14 Mangilit, Ronald 302.50 302.50 605.00
15 Quebral,Leo 206.25 206.25 412.50
16 Ramos, Cleotilde 330.00 330.00 660.00
17 Solloso,Jose Emmanuel 192.50 192.50 385.00
18 Ulanday, Eddie 275.00 275.00 550.00
19 Yamson,Geraldine 206.25 206.25 412.50

Total Amount 4,633.23 4,633.23 9,266.46

 HQP-PFF-053

MEMBERSHIP SAVINGS Pag-IBIG EMPLOYER'S ID NUMBER

REMITTANCE FORM ( MSRF ) 201179970005

NOTE: PLEASE READ INSTRUCTIONS AT THE BACK

EMPLOYER/BUSINESS NAME
CARGEM MANAGEMENT CORPORATION
EMPLOYER/BUSINESS NAME
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. Street Name
RM. 1202 P&E BLDG. House No NO. 12 UNITED COR. FIRST ST.
Subdivision Baran Municipality/City Province/State/Country (if abroad) Zip Code
gay
BO. KAPITOLYO PASIG CITY
NAME OF MEMBERS MONTHLY MEMBERSHIP SAVINGS
ACCOUNT MEMBE PERIOD COMPENSAT
Pag-IBIG RSHIP Last Name First Name NAME EXT. Middle Name ION EE ER
NO PROGR COVERED
MID NO. TOTAL
AM (JR., III, ETC)
SHARE SHARE

1211-1829-9581 ANTOLIN EMELITA SAGUN 100.00 100.00 200.00

1090-0100-2312 ARAZA GERONIMO RAMOS 100.00 100.00 200.00
1211-7126-8433 BALURAN JAYSAN PITOGO 100.00 100.00 200.00
1212-4402-5551 BUHIA GENALYN YAMSON 100.00 100.00 200.00
1210-8029-9078 CADIZ MICHAEL DESIERTO 100.00 100.00 200.00
1211-0449-0548 CADIZ EDWARD JOSEPH DESIERTO 100.00 100.00 200.00
1211-1539-1479 CALILAN CRISANTO PAMILACAN OCT. 2019 100.00 100.00 200.00
1210-8006-1477 CAUDILLA CHRISTEN JOY TOLEDO 100.00 100.00 200.00
1080-0005-6318 CORONADO MICHAEL III BERNARDO 100.00 100.00 200.00
1090-0114-8675 DOLOR IVY ARCE 100.00 100.00 200.00
1090-0100-2323 GELACIO GERALDINE PALTENG 100.00 100.00 200.00
1211-3555-9559 HOMO EDISON LESANO 100.00 100.00 200.00
1080-0006-0395 INDONG EDGARDO PLICERDA 100.00 100.00 200.00
1210-4688-7024 MANGILIT RONALD ORDOÑA 100.00 100.00 200.00
1210-9999-0620 QUEBRAL LEO RAMOS 100.00 100.00 200.00
1210-1578-3832 RAMOS CLEOTILDE ARBASTO 100.00 100.00 200.00
1210-6851-2151 SOLLOSO JOSE EMMANUEL BUO 100.00 100.00 200.00
1211-0213-4102 ULANDAY EDDIE DELA CRUZ 100.00 100.00 200.00
1212-0471-7716 YAMSON GERALDINE ISIDRO 100.00 100.00 200.00

*******************NOTHING FOLLOWS******************

TOTAL FOR THIS PAGE 1,900.00 1,900.00 3,800.00

GRAND TOTAL (if last page) 1,900.00 1,900.00 3,800.00
EMPLOYER CERTIFICATION

I hereby certify under pain of perjury that the information given and all statements made herein are true and correct to the best of my knowledge and belief. I further
certify that my signature appearing herein is genuine and authentic.

IVY A. DOLOR VP FOR ADMIN & INTERNAL AFFAIRS 6-Sep-19

HEAD OF OFFICE OR AUTHORIZED REPRESENTATIVE DESIGNATION/POSITION DATE
(Signature Over Printed Name)

THIS FORM MAY REPRODUCED. NOT FOR SALE (V03, 10/2016)

 HQP-PFF-053

0005

me
OR. FIRST ST.

REMARKS

3,800.00
3,800.00

e and belief. I further

(V03, 10/2016)