DOMINICO LAUDE

Maxicare Healthcare Corporation Maxicare Tower 203 Salcedo Street Brgy. San Lorenzo Legaspi Village Makati City 1229 VAT REG. TIN 000-487-637-00000 BILLING INVOICE Invoice Date: December 04, 2020 PAYMENT DUE DATES DOMINICO LAUDE Invoice Number 1000272324 GUARDIAN Payment Reference Number 10002723244 1602196315 - DOMINICO LAUDE Total Amount Due on 12 Railway St. Lapaz Iloilo City 0000 February 01, 2021 PHP 6,308.00 BUS. STYLE: N/A Mode of Payment Quarterly DIRECT Coverage Period February 01, 2021 - January 31, 2022 Please remit to Maxicare Healthcare Corporation the amount of ***SIX THOUSAND THREE HUNDRED EIGHT PESOS ONLY*** (PHP 6,308.00) in payment of the following: BILLING INVOICE Billing Period Covering: February 01, 2021 - April 30, 2021 Accounting Document Transaction Type Amount 6,308.00 8100113557 Renewal 6,308.00 VAT Sales 5,632.14 6,308.00 VAT Exempt Sales - Zero Rated Sales - 112.64 VAT Amount 6,195.36 Total Sales 675.86 Total Amount Due for Non withholding Tax Agent PHP Less: Withholding Tax, if Withholding Agent (ATC Code: WC160) PHP TOTAL AMOUNT DUE For Withholding Tax Agent Please settle your account on or before February 01, 2021 to ensure continuity of coverage. Further, please notify us immediately of any billing error in the Billing Invoice (BI). If no error is reported within fifteen calendar (15) days from Invoice Date, the Billing Invoice shall be considered final and accurate. Important Reminders: 1. Any transactions made after the generation of this Billing Invoice will be reflected in your subsequent billing statements. 2. To all withholding agents: Submit corresponding certificate of tax withheld (BIR Form No. 2307) to Maxicare upon remittance of payment. Failure to provide CWT Certificate, the amount will form part of your Outstanding Balance. 3. If your due date falls on a weekend or holiday, please settle on the last working day before due date. 4. Please inform us on any changes on your billing address and/or contact number. 5. Penalty and/or suspension may be charged/implemented in case of delayed or non-payment. 6. Accredited Collection Partners: Equicom Savings Bank (EqB), BPI, Metrobank, PNB, Security Bank, Unionbank, RCBC or BDO (through Bills Payment Facility); CIS Bayad Center. Payment through our collection partners shall be credited within 3 working days from actual remittance. *For Suggestions or other inquiries, you can send an email to [email protected] Accreditation No.: Date of Accreditation: Permit To Use (PTU) No.: 1812_0126_PTU_CAS_000418 Date Issued: DECEMBER 28, 2018 Valid Until: DECEMBER 31, 2023 Form No.: 1000000001 - 1999999999 THIS DOCUMENT IS NOT VALID FOR CLAIM OF INPUT TAX THIS DOCUMENT SHALL BE VALID FOR FIVE (5) YEARS FROM THE DATE OF THE PERMIT TO USE. THIS BILLING INVOICE IS A SYSTEM GENERATED FORM. SIGNATURE IS NOT REQUIRED. ------------------------------------------------------------------------------------------------------------------------ (KINDLY SURRENDER THIS PORTION TO THE CASHIER DURING PAYMENT) DOMINICO LAUDE COVERED PERIOD GUARDIAN February 01, 2021 - January 31, 2022 1602196315 - DOMINICO LAUDE 12 Railway St. Lapaz Iloilo City 0000 ( ) Check Bank: _____________ Check No.: _________ DUE DATE ( ) Credit Card Number: ____________________________________ February 01, 2021 ( ) Cash Amount Paid: _______________________