PhilHealth Please Read Instruction at the Back Before Accomplishing This Form

Fill PhilHealth Please Read Instruction at the Back Before Accomplishing This Form online and download the official form as a PDF, ready to print. Every input is mapped to its printed box, so IDs, dates and amounts land digit by digit in the right cells, and a value the form cannot hold is refused with the reason instead of being printed wrong.

What you will need: INITIAL LIST (Attach to PhilHealth Form Er1), NAME OF EMPLOYER/FIRM, EMPLOYER NO, ADDRESS, E-MAIL ADDRESS, NAME OF EMPLOYEE, TOTAL NO. LISTED ABOVE, PAGE ___ OF ___ SHEETS, SIGNATURE OVER PRINTED NAME.

The form is the agency's own, from philhealth.gov.ph (checked 2026-10-14): the PDF you download is that form with your values printed in its boxes.

Part of the form pack: Small office with 1–10 employees (When you hire someone new).

The free clean PDF is that pack’s shortest form. A later form in the same pack needs the Starter plan (₱499) or above. Preview, check, and verify stay free. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.

Fill PhilHealth Please Read Instruction at the Back Before Accomplishing This Form now

• Form pack: Small office with 1–10 employees
• The blank form from philhealth.gov.ph