INVOICE - 312462 Date: Jul 9, 2026 at 12:08 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 Address:

ity: i 311-318 Agnes st
: New We
ee = ee New Westminster , BC

V3L0)3
Postal: \3L0J3 Gender: M

Birth Date ; 1978-09-04
Bill Details
Dite.<_Piecitioner Payee Ref. Bostor ee Ref. Rockit Ref. Tyne

2026-03- Ademiluyi (68199),
13 Gbogboade

Line#t Description Codes Unit Fee

Written /Brief Certificate/Form including
school/work time off, medical certificate
for government employment insurance,
312462 SPARC-BC Parking Application, Handy © A00060 ‘ 780 52.90 2:65 55.55
Dart & Handy Card Application + WCB &
ICBC Brief letter/note including insurance
note for physiotherapy/massage therapy
2026-03-18

Payment(MASTERCARD) 4003-18 =

Please Make Cheque Payable To: Subtotal: Sea

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:
Medical Cert for EI - for collection c/o cr - form linked - sol