PhilHealth Please Read Instruction At The Back Before Accomplishing This Form

Fill PhilHealth Please Read Instruction At The Back Before Accomplishing This Form online and download the official form as a PDF, ready to print. Every input is mapped to its printed box, so IDs, dates and amounts land digit by digit in the right cells, and a value the form cannot hold is refused with the reason instead of being printed wrong.

What you will need: INITIAL LIST (Attach to PhilHealth Form Er1), NAME OF EMPLOYER/FIRM, EMPLOYER NO, ADDRESS, E-MAIL ADDRESS, NAME OF EMPLOYEE, TOTAL NO. LISTED ABOVE, PAGE ___ OF ___ SHEETS, SIGNATURE OVER PRINTED NAME.

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