PhilHealth Annex G: Transmittal Form
Fill PhilHealth Annex G: Transmittal 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: NAME OF CONTRACTED HEALTH FACILITY, Case Number, Printed Name and Signature, Designation, Date signed (mm/dd/yyyy).
Free to try: 5 forms a day without an account; a free account gets 14 days of clean PDFs, then 25 a month. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.