This document is a sworn declaration form from the Philippine Health Insurance Corporation (PhilHealth) regarding identification of relatives employed at PhilHealth. The form requires the declarer to state whether they have any relatives within the third degree of consanguinity or affinity employed at PhilHealth, and if so to provide their names and relationships. It also defines consanguinity and affinity up to the third degree. The declarer must sign and date the form, swearing it is a true statement pursuant to corporate policies regarding nepotism and hiring of relatives.
This document is a sworn declaration form from the Philippine Health Insurance Corporation (PhilHealth) regarding identification of relatives employed at PhilHealth. The form requires the declarer to state whether they have any relatives within the third degree of consanguinity or affinity employed at PhilHealth, and if so to provide their names and relationships. It also defines consanguinity and affinity up to the third degree. The declarer must sign and date the form, swearing it is a true statement pursuant to corporate policies regarding nepotism and hiring of relatives.
Original Title
Vdocuments.mx Sworn Declaration of Relatives Philhealth
This document is a sworn declaration form from the Philippine Health Insurance Corporation (PhilHealth) regarding identification of relatives employed at PhilHealth. The form requires the declarer to state whether they have any relatives within the third degree of consanguinity or affinity employed at PhilHealth, and if so to provide their names and relationships. It also defines consanguinity and affinity up to the third degree. The declarer must sign and date the form, swearing it is a true statement pursuant to corporate policies regarding nepotism and hiring of relatives.
This document is a sworn declaration form from the Philippine Health Insurance Corporation (PhilHealth) regarding identification of relatives employed at PhilHealth. The form requires the declarer to state whether they have any relatives within the third degree of consanguinity or affinity employed at PhilHealth, and if so to provide their names and relationships. It also defines consanguinity and affinity up to the third degree. The declarer must sign and date the form, swearing it is a true statement pursuant to corporate policies regarding nepotism and hiring of relatives.
PHILIPPINE HEALTH INSURANCE CORPORATION Citystate Centre, 709 Shaw Boulevard, Pasig City Call Center (02) 441-7442 Trunkline (02) 441-7444 www.philhealth.gov.ph
SWORN DECLARATION/IDENTIFICATION OF RELATIVES IN PHILHEALTH
(Pursuant to Corporate Policy on Nepotism and Hiring of Next-of-Kin)
I, Mr./Ms. __________________________________________ of legal age, presently
residing at __________________________________________________________________
[ ] do hereby declare that I do not have any relatives
[ ] do hereby declare/identify the following as my relative/s or member/s of my family within the third degree either of consanguinity or of affinity who is/are connected/employed with PhilHealth as either employee/job order contractor: NAME RELATIONSHIP
It is hereby understood that “relative” or “family member” within the third degree either of consanguinity or of affinity refers to the following: Consanguinity Af fi ni ty (includes individuals related by blood) (includes the individuals Spouse and Related to the Spouse) First Degree Second Degree Third Degree First Degree Second Degree Third Degree Father and Mother Brother and Sister Uncle and Aunt Spouse Brother-in-Law Uncle-in-law and and Sister-in-law Aunt-in-law Son and Daughter Grandfather and Nephew and Father-in-law and Grandfather-in-law Nephew-in-law Grandmother Niece Mother-in-law and Grandmother- and Niece-in-law in-law Grandson and Son-in-law or Grandson-in-law Granddaughter Daughter-in-law and Granddaughter-in- law
Also, I declare that:
[ ] do not have a relative previously employed in PhilHealth that has retired, died or became incapacitated (permanent or total disability). [ ] I am a relative of _____________________________________ (name of PhilHealth employee) who has (retired/died/became incapacitated) Please underline. I am his/her (spouse/son/daughter/brother/sister) Please underline.
I declare under oath that this document has been accomplished by me, and is a true, correct and complete statement pursuant to the provisions of pertinent laws and corporate rules and regulations. I also authorize the agency head/authorized representative to verify/validate the contents stated herein. I trust that this information shall remain confidential. Signed at _________________ City on _______________________. ( date)
_______________________________ Printed Name and Signature
