Scribd
Upload
977 views3 pages

Philhealth: Report of Employee - Members Name of Employer/Firm: Employer No: Address: E-Mail Address

This document is a PhilHealth report form for employers to report employee members. It contains instructions for employers to fill out the form correctly. The form collects information such as employee name, position, salary, date of employment and previous employer. Employers are instructed to submit the form in duplicate along with an employer data record form to register new employees with PhilHealth or report newly hired employees if already registered. All columns must be filled out correctly except the effective date of coverage column. Accurate reporting of employer name and number is important for payments to be credited properly.

Uploaded by

LadyAngelIgnacioValguna
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
977 views3 pages

Philhealth: Report of Employee - Members Name of Employer/Firm: Employer No: Address: E-Mail Address

This document is a PhilHealth report form for employers to report employee members. It contains instructions for employers to fill out the form correctly. The form collects information such as employee name, position, salary, date of employment and previous employer. Employers are instructed to submit the form in duplicate along with an employer data record form to register new employees with PhilHealth or report newly hired employees if already registered. All columns must be filled out correctly except the effective date of coverage column. Accurate reporting of employer name and number is important for payments to be credited properly.

Uploaded by

LadyAngelIgnacioValguna
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
You are on page 1/ 3

PLEASE READ INSTRUCTIONS AT THE BACK BEFORE ACCOMPLISHING THIS FORM.

PHILHEALTH
REPORT OF EMPLOYEE - MEMBERS

NAME OF EMPLOYER/FIRM:
(CHECK APPLICABLE BOX) INITIAL LIST (Attach to PhilHealth Form Er1) SUBSEQUENT LIST

Employer No:
Er2
ADDRESS: E-MAIL ADDRESS:
(DO NOT FILL)
PHILHEALTH/SSS/GSIS NAME OF EMPLOYEE POSITION SALARY DATE OF EFF. DATE OF PREVIOUS EMPLOYER
NUMBER EMPLOYMENT COVERAGE ( IF ANY )
Surname Given name Middle name
2005696180 VALGUNA LADY ANGEL IGNACIO TEACHER I 20, 750.00 Sep-19 N/A

TOTAL NO. LISTED ABOVE: CERTIFIED CORRECT:


One (1)

Human Resource Management Officer II


PAGE_1__ OF __1__SHEETS SIGNATURE OVER PRINTED NAME
TO BE ACCOMPLISHED IN DUPLICATE.
Note: This form can be reproduced but not for sale.
INSTRUCTIONS

1. An employer who is not yet registered with PhilHealth will submit this form in two (2) copies together with the "Employer Data
Record ", in two (2) copies also.

2. An employer already registered with PhilHealth will submit this form in two (2) copies to PhilHealth to report (a) newly hired
employee(s). The PhilHealth Number of the employee (which was shown to the Employer) should be written in the first column
of this form.

3. ALL COLUMNS SHALL BE FILLED CORRECTLY, except the column with the heading "EFF. DATE OF COVERAGE".

4. IT IS IMPORTANT THAT YOU INDICATE YOUR REGISTERED NAME AND EMPLOYER NUMBER IN YOUR REMITTANCE
(PhilHealth Form RF1) ACCURATELY. OTHERWISE, YOUR PAYMENTS CAN NOT BE CREDITED TO YOUR ACCOUNT.

You might also like