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PhilHealth Er2 Form PDF

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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JOHN SPARKS
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6K views2 pages

PhilHealth Er2 Form PDF

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.

Uploaded by

JOHN SPARKS
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: 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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