INVOICE - 326969 Date: Jul 9, 2026 at 12:27 pM"

Foremed Clinic

420 Columbia St., New Westminster, BC V3L 1B1
Telephone: 604 522 2206

Fax: 604 522 7206

Billing To [Search] Patient ( 9128549738 )
Name: MARK THOMAS HOLAND Name: HOLAND , MARK THOMAS
Address: 311-318 Agnes st satel ,

aa 4 - gnes s
ere Hen: Westuniney New Westminster , BC
Province: BC V3L033
Postal: V3L0J3 Gender: M

Birth Date : 1978-09-04
Bill Details

Date Practitioner Payee Ref. Doctor Ref. Type Ref. pasine arias
2026-05- Ademiluyi (68199),
16 Gbogboade
Line# Description eo QTY pane Unit Fee sa Amount

Written /Brief Certificate/Form including
school/work time off, medical certificate for
government employment insurance, SPARC-BC

326969 Parking Application, Handy Dart & Handy Card A00060 1.0 780 52.90 2.65 55.55

Application + WCB & ICBC Brief letter/note

including insurance note for
physiotherapy/massage therapy

2026-05-19

Payment{DEBIT) 41:12:39.0 aie

re ar te eee | 2
Please Make Cheque Payable To: Subtotal: 52.90
F. Kara Holdings Lower Ltd. GST Total: 2.65

420 Columbia Street, New Westminster, BC, V3L 2X2 Total: 55.55
Telephone: 604-522-2206 Payments: 55.55
Fax: 604-522-7206 Refunds: 0.00

registration@secure.foremedclinic.com

Balance: 0.00

Billing Notes:

ServCanada - Medical EI for Sickness Benefit - for collection c/o sb -
form linked - sol

4