PhilHealth PMRF: PhilHealth Member Registration Form

Fill PhilHealth PMRF: PhilHealth Member Registration 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: PHILHEALTH IDENTIFICATION NUMBER (PIN), PURPOSE, Preferred KonSulTa Provider, MEMBER LAST NAME, MEMBER FIRST NAME, MEMBER NAME EXTENSION (Jr./Sr./III), MEMBER MIDDLE NAME, MEMBER NO MIDDLE NAME, MEMBER MONONYM, MOTHER’s MAIDEN NAME LAST NAME, MOTHER’s MAIDEN NAME FIRST NAME, MOTHER’s MAIDEN NAME NAME EXTENSION (Jr./Sr./III).

Before you file: First-time registrants: bring a valid proof of identity. Updating dependents: bring documents proving the relationship. Write names as on the birth certificate, including your mother's full maiden name, in capital letters. Self-earning members, kasambahay and family drivers state their actual monthly income. Sign over your printed name (or thumbmark) and date it.

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 these form packs: Start a business on your own (sole proprietor) (Register, or update your record from employee to self-earning member); Overseas Filipino worker (land-based) (Register or update your record as an overseas Filipino member); Your first job: TIN, SSS, PhilHealth and Pag-IBIG (Only if you have no PhilHealth number yet. Tick Registration as the purpose); Just married: update your name and status everywhere (Tick Updating/Amendment: civil status, surname, and your spouse as a dependent); Moved house: update your address with SSS, PhilHealth, Pag-IBIG and BIR (Tick Updating/Amendment and give the new address); Fix a wrong name or birthdate on your SSS, PhilHealth, Pag-IBIG and BIR records (Tick Updating/Amendment and give the details exactly as on your PSA birth certificate).

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 PMRF now