INVOICE - 311753

Foremed Clinic

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

Fax: 604 522 7206

Billing To [Search]

Name: Worksafe BC Payment Services
Address: PO BOX 4700 Stn. Terminal
City: Vancouver

Province: BC

Postal:

Bill Details

Date

2026-03- Ademiluyi (68199),
12 Gbogboade

Practitioner Payee

Line# Description

311753 CHRT NTE

Please Make Cheque Payable To:
F. Kara Holdings Lower Ltd.

420 Columbia Street, New Westminster, BC, V3L 2X2

Telephone: 604-522-2206
Fax: 604-522-7206
registration@secure.foremedclinic.com

Billing Notes:
WCB no. 42647461 Payee no. 15019

WORKSAFEBC REQ'D COPY OF AN EXIST RPRT OR

Ref. Doctor
EE

Service
Code
19953

gry x

1.0 158,22

Date: Jul 9, 2026 at 12:06 PM

Patient ( 9128549738 )

Name: HOLAND , MARK THOMAS
Address:

311-318 Agnes st

New Westminster , BC

V3L0)3

Gender: M

Birth Date : 1978-09-04

Ref. Type Ref.Doctor Ref. Type

Total

Cod Unit Fee GST Amount

0.00 158.22

Subtotal: 158.22
GST Total: 0.00
Total: 158,22
Payments: 0.00
Refunds: 0.00

Balance 158.22