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    PhilHealth Er2 Form PDF

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    JOHN SPARKS
    This document is an employee list that employers submit to PhilHealth to enroll their employees in health insurance. It instructs the employer to read instructions on the back before filling out the form. The form collects information about the employer like name, address and email. It then lists each employee's name, position, salary, date of employment, SSS/GSIS number and previous employer. The employer signs and dates the form and notes the total number of employees listed and the page number.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    PhilHealth Er2 Form PDF

    Uploaded by

    JOHN SPARKS
    4K views2 pages
    This document is an employee list that employers submit to PhilHealth to enroll their employees in health insurance. It instructs the employer to read instructions on the back before filling out the form. The form collects information about the employer like name, address and email. It then lists each employee's name, position, salary, date of employment, SSS/GSIS number and previous employer. The employer signs and dates the form and notes the total number of employees listed and the page number.

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    PhilHealth Er2 Form.pdf

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    This document is an employee list that employers submit to PhilHealth to enroll their employees in health insurance. It instructs the employer to read instructions on the back before filling out the form. The form collects information about the employer like name, address and email. It then lists each employee's name, position, salary, date of employment, SSS/GSIS number and previous employer. The employer signs and dates the form and notes the total number of employees listed and the page number.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4K views2 pages

    PhilHealth Er2 Form PDF

    Uploaded by

    JOHN SPARKS
    This document is an employee list that employers submit to PhilHealth to enroll their employees in health insurance. It instructs the employer to read instructions on the back before filling out the form. The form collects information about the employer like name, address and email. It then lists each employee's name, position, salary, date of employment, SSS/GSIS number and previous employer. The employer signs and dates the form and notes the total number of employees listed and the page number.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    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: EMPLOYER NO.

    ADDRESS: E-MAIL ADDRESS:


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

    TOTAL NO. LISTED ABOVE:


    PAGE ___ OF ___ SHEETS SIGNATURE OVER PRINTED NAME

    TO BE ACCOMPLISHED IN DUPLICATE

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