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    Moder Solutions Inc Etiqa 07448 202310-00231248 Coverpage

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    eufemi

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    © All Rights Reserved
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    Moder Solutions Inc Etiqa 07448 202310-00231248 Coverpage

    Uploaded by

    eufemi
    13 views2 pages

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    13 views2 pages

    Moder Solutions Inc Etiqa 07448 202310-00231248 Coverpage

    Uploaded by

    eufemi

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    3rd Flr, Morning Star Center, #347 Sen.

    Gil Puyat
    Avenue, Makati, Tel (632) 8890-1758
    NON VAT REG TIN: 007-884-672-000
    BIR Permit No: AC_125_032021_000036

    STATEMENT OF ACCOUNT
    Policy No: 07448 Reference No: SOA202310-00231248
    Policy Holder: MODER SOLUTIONS, INC. SOA Date: 10/10/2023
    Address: 5/F Park Centrale Building, Jose Maria Del Mar St. cor. Mode of Payment: A
    Abad St., Cebu IT Park, Cebu City
    Business MODER SOLUTIONS, INC. Policy Modal Date: 08/15/2023
    Style:
    TIN:
    Tax Type:
    PEZA Reg. Summary
    No.:
    Attention: MR. ERIK ANDERSON Current Amount Billed: 955,579.27
    Outstanding Balance (as of 0.00
    10/10/2023):

    Total Amount Due: 955,579.27

    ADJUSTMENT DUE TO INCLUSION


    Member count Amount of Amount Rate Total Amount Due
    Insurance
    MED 955,579.27
    Current Amount Billed: 955,579.27
    Plan Code Description:

    APE ANNUAL PHYSICAL EXAM DENR DENTAL FEE

    MED MEDICAL PLAN NACR NETWORK ACCESS

    Remarks:
    Kindly review the Statement of Account, if no reply is given within 5 days, we will assume that the bill is correct and is demandable 7 days
    from the receipt of bill.
    Any inclusions/deletions not included in this billing shall be reflected on the next SOA
    Premium Inclusive of Other Fees

    Thank you and we hope to receive your payment soon.


    Prepared By: Noted By
    VIDAL E JOSUE TOM B CLARION
    BILLING ADMINISTRATOR TEAM LEADER
    Disclaimer: This is a system generated SOA and does not require signature.

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