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Er 2

In 3 sentences: The document is a PhilHealth report listing an employee named Erlyn P. Veniegas who works as an Administrative Assistant II for the DepEd Surigao del Sur Division. It provides her salary and dates of employment and PhilHealth coverage. The report is the initial list for the employer and is to be completed in duplicate according to the instructions on the back of the form.

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Patrick Go
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762 views2 pages

Er 2

In 3 sentences: The document is a PhilHealth report listing an employee named Erlyn P. Veniegas who works as an Administrative Assistant II for the DepEd Surigao del Sur Division. It provides her salary and dates of employment and PhilHealth coverage. The report is the initial list for the employer and is to be completed in duplicate according to the instructions on the back of the form.

Uploaded by

Patrick Go
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PLEASE READ INSTRUCTION AT THE BACK BEFORE ACCOMPLISHING THIS FORM

(CHECK APPLICABLE BOX)


PHILHEALTH INITIAL LIST (Attach to PhilHealth Form Er1)
REPORT OF EMPLOYEE-MEMBERS SUBSEQUENT LIST

NAME OF EMPLOYER/FIRM: DEPED


SURIGAO DEL SUR DIVISION EMPLOYER NO. 019000014020

ADDRESS: BALILAHAN, MABUA, TANDAG CITY E-MAIL ADDRESS: [email protected]


PHILHEALTH DATE OF (DO NOT FILL)
EFF. DATE OF PREVIOUS EMPLOYER
SSS/GSIS NAME OF EMPLOYEE POSITION SALARY EMPLOY-
COVERAGE ( IF ANY)
NUMBER MENT

ERLYN P. VENIEGAS ADMINISTRATIVE 16,758 06/20/2019


ASSISTANT II

TOTAL NO. LISTED ABOVE:


PAGE ___ OF ___ SHEETS SIGNATURE OVER PRINTED NAME

TO BE ACCOMPLISHED IN DUPLICATE

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