PhilHealth Premium Payment Slip
Fill PhilHealth Premium Payment Slip 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: PIN/POGN/PEN/PSN, MEMBER’S NAME, HOUSEHOLD EMPLOYER/ SPONSOR/AGENCY NAME, MEMBER TYPE: (Please mark only one), APPLICABLE PERIOD: FROM, APPLICABLE PERIOD: TO, MEMBER CONTACT NO. EMAIL ADDRESS, AMOUNT PAID.
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.
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.