PhilHealth Employer No.: Republic of the Philippines PHILIPPINE HEALTH INSURANCE CORPORATION Citystate Centre 709 Shaw Boulevard, Pasig City Healthline 637-9999 www.philhealth.gov.ph EMPLOYER DATA RECORD

ER1: Employer Data Record; ER2: Report of Employee-Members; ER3: Employer Data Amendment Form; RF1: Employer's Remittance Report; PhilHealth Employers' Engagement Representative (PEER) Information Sheet; Non Disclosure Agreement; Accredited Collecting Agents (ACAs) Non-Disclosure Agreement (NDA) PhilHealth Online Access Form (POAF) …

Employer Data Record (ER1) Form (in duplicate) PhilHealth Membership Registration Form (PMRF) for each employee (in duplicate) Kasambahay Employer. Submit the following to any PhilHealth Office: Household Employer Unified Registration Form; Household Employment Unified Report Form; Kasambahay Unified Registration Form

initial list (attach to philhealth form er1) subsequent list address: e-mail address: employer no. total no. listed above: page ___ of ___ sheets signature over printed name to be accomplished in duplicate philhealth sss/gsis number name of employee position salary date of employ-ment (do not fill) eff. date of coverage previous employer ( if any)

Registration procedures for newly hired and existing employees without PIN yet. Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF); Submit PMRF to the HR Department of employer

Reporting your Employees. Responsible employers ensure that all workers under their employ are dutifully reported to PhilHealth so that in times of need, they can readily rely on accurate records, especially of their premium contributions.

Employees enrolling with PhilHealth for the first time shall submit to his/her employer duly accomplished two copies of Member Data Record for Employed Sector (M1a) Form and attach clear copy of any

Electronic Collection Reporting System Login. Enables PhilHealth Accredited Collecting Agents to submit daily RF2 reports online

PMRF. PHILHEALTH IDENTIFICATION NUMBER (PIN) UHC v.1 January 2020. I. PERSONAL DETAILS DATE OF BIRTH. d d. y y y y. CITIZENSHIP. Male. Female. SEX. m m

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