INVOICE - 305255 Date: Jul 9, 2026 at 11:57 AM

Foremed Clinic

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

Fax: 604 522 7206

Billing To [S

Name? MARK THOMAS HOLAND
dress; 311-318 Agnes st

ity: New Westminster
Province: BC
Postal: V3L0J3

Patient ( 9128549738 )

Name: HOLAND , MARK THOMAS
Address:

311-318 Agnes st

New Westminster , BC

V3L033

Gender: M

Birth Date : 1978-09-04

tails

Date Practitioner Payee Ref, Doctor _ Ref. 7 Tyne Rat, Doctor =
2026-02- Ademiluyi (68199),
12 Gbogboade
Line# Description ey gry cox, Unit Fee mount
APS Short Form / Continuing
305255 Disability, Wage Indemnity etc A0015 1.0 150.00 7.50 157.50
2026-02-13
Payment(MASTERCARD) 10:42:15.0 (157.50)

Subtotal: 150.00
GST Total: 7.50

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

420 Columbia Street, New Westminster, BC, V3L 2X2 Total: 157.50
Telephone: 604-522-2206 Payments: 157.50
Fax: 604-522-7206 Refunds: 0.00

registration@secure.foremedclinic.com Balance : 0.00