2026/Mar/28 1:45:17 PM

To; +16045205552 Page: 2/2

Mar 26, 2026 01:44

INVOICE - 315113
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Foremed Clinic

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

Fax: 604 522.7206

Billing To [Search]

Name: BC Translink - Occupational & Wellness
Address: f : 604-520-5552

City:

Province:

Postal:

Bill Details

Ref. Doctor
Date Payee 7

2026-03- Ademiluyi (68199),
4 Gbogboade
315113 Employer's Occupational Fitness Assessment ~ extra
to examination (BCMA Rates)

Practitioner

Service
fade

A94529

16043985614->555-1212

From: Foremed Medical Clinic

Date: Mar 26, 2026 at 1:27 PM

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Patient ( 9128549738 )}

Name: HOLAND , MARK THOMAS
Address:

314-318 Agnes st

New Westminster , BC

V3L0)3

Gender: M

Birth Date ; 1978-09-04

Ref. Type

Ref. Doctor Ref. Type

DX . Total
QTY codes UnitFee “gsr Amount

1.0 780 213.00 10.65 223.65

ee errr
Subtotal: 213.00

Please Make Cheque Payable To:

F. Kara Holdings Lower Ltd.

420 Columbia Street, New Westminster, BC, V3L 2X2
Telephone: 604522-2206

Fax: 604-522-7206
registration@secure.foremeddinic.com

GST Total: 10.65
Total: 223.65
Payments: 0.00
Refunds: 0.00
Balance 993.65

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Fax: 16043985614

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