MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This MEMORANDUM OF AGREEMENT, made and entered into by:

_______________________________., a corporation duly organized and existing

under and by virtue of Philippine Laws with principal office at
__________________________, represented by its President & CEO,
________________________, hereinafter referred to as the COMPANY;

And

__________________________________ , likewise a health care institution

providing patient treatment with specialized medical and nursing staff and
medical equipment, duly organized and existing under and by virtue of
Philippine Laws, with principal office at
_____________________________________, represented by its
___________________, ____________________________, hereinafter referred to as
the HOSPITAL;

WITNESSETH THAT

WHEREAS, the COMPANY needs a facility which can provide a patient

treatment with specialized medical and nursing staff and medical equipment
services for its members;

WHEREAS, the HOSPITAL has facilities needed/required by the

COMPANY and is willing to provide the same to the COMPANY;

NOW, THEREFORE, for and in consideration of the foregoing premises,

the parties have agreed and by these presents, do hereby agree to make and
enter into this Agreement and hereby further agree to abide with the following
covenants hereinafter stipulated to wit:

1. The COMPANY shall refer to the HOSPITAL and the HOSPITAL

shall accommodate COMPANY members with valid membership card
and provide laboratory/diagnostic services.

2. The COMPANY shall be informed by the HOSPITAL during medical

availment of its members and provide information as requested by
the COMPANY in order to verify eligibility of membership and schedule
of medical benefits.
 The COMPANY shall provide the HOSPITAL with a Letter of Authorization
(LOA) for every medical availment that is within the schedule of
benefit as declared by the medical insurance provider of the member.

The COMPANY will not be held liable by the HOSPITAL to pay for any
medical availment of its member with no LOA.

5. The HOSPITAL shall honor the LOA issued by the COMPANY for the
medical availment of its member. The LOA shall state payment by the
COMPANY of the expenses incurred by the member within benefit limits.

6. The HOSPITAL shall collect from the member the excess amount
incurred during medical availment not covered by the LOA prior to
release from the facility. The HOSPITAL shall have no recourse to
any reimbursement from the COMP ANY should it fail to charge and
collect any expenses charge to COMP ANY members.

7. The HOSPITAL shall use its best resources and facilities to

provide medical and surgical services required by COMPANY
members.

8. The HOSPITAL shall provide the COMP ANY with medical

information of the case such as diagnosis, treatment,
laboratory/diagnostic procedure to be done and complete access to
the member's medical record with the consent of the Attending
Physician.

9. The HOSPITAL shall accommodate the COMPANY Liaison Officers

by allowing them to assist COMPANY members during their out-
patient medical availment and be able to explain their medical
insurance benefits and coverage limits.

10. The HOSPITAL shall display COMPANY signage at the

Reception/Information Office which would guide COMP ANY members
during their medical availment.

11. The HOSPITAL shall send original statement of account to the

COMPANY within seven (7) days from the time of availment at the
following address:

MARZAN HEALTHCARE
Claims Department
#33 V. Luna Ave., Brgy. Pinyahan, Quezon City

The statement of account with corresponding LOA reflects the

actual laboratory bill (itemized) for services rendered to COMPANY
members.
12. The HOSPITAL shall grant the COMPANY allowable credit period of
thirty (30) days from receipt of original statement of account. Within
this period, the COMPANY shall settle the amount due to the
HOSPITAL.

13. The HOSPITAL shall grant the COMPANY a _________ percent ( %)

prompt payment discount from the total medical bill for payments
made within thirty (30) days from receipt of original statement of
account.

14. In case of default in the payment of any obligations by the COMPANY,

the HOSPITAL shall suspend the COMP ANY by not accommodating
the medical availment of its members until such time that the
COMPANY has settled its obligations. The suspension of the
COMPANY shall take effect if payment is not made within thirty (30)
days from receipt of original statement of account.

15. In case litigation arising from this Agreement, the parties hereby
agree that exclusive jurisdiction shall be vested in the courts of Quezon
City, Metro Manila.

16. This Agreement shall be for a period of one year from the date
hereof, and shall be automatically renewed every year thereafter,
unless either party gives notice of its intention to terminate or
modify the condition of the agreement at least sixty (60) days
before
intended date of termination or modification.

IN WITNESS WHEREOF, the parties have set their hands this ___________
at _____________________ in _______________________.

MARZAN HEALTHCARE ________________________________

COMPANY HOSPITAL

BY: BY:

EDISON B. MARZAN _______________________________

CEO PRESIDENT HOSPITAL

ACKNOWLEDGMENT
Republic of the Philippines)
_________________________ ) S.S.

Before me, a Notary Public in and for __________________, personally appeared

the following:

Name T.I.N. Date and Place of Issue

__________________________
__________________________

Known to me to be the same persons who executed the foregoing Memorandum

of Agreement and that they both acknowledge the same to be their free and
voluntary act and of the principals that they represent.

The foregoing Agreement consists of ___________ (______) pages, including the

page on which this acknowledgment is written and is signed by the parties and
their instrumental witnesses at the foot of the document, and on the left
margin of every page.

WITNESS MY HAND AND SEAL, affixed on the date and place first above
written.

NOTARY PUBLIC
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 2017