PhilHealth Payment Slip (Household) PhilHealth Slip (Household): Annex
Fill PhilHealth Payment Slip (Household) PhilHealth Slip (Household): Annex 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 OF KASAMBAHAY, NAME OF KASAMBAHAY, PEN of HOUSEHOLD EMPLOYER, NAME OF HOUSEHOLD EMPLOYER, APPLICABLE PERIOD, AMOUNT PAID PHP, Printed Name and Signature of Household Employer.
When it is due: On or before the 25th of the month following the applicable month; a Saturday, Sunday or holiday rolls to the next working day (PhilHealth Circular 016-2015, III.D.1).
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: Register your kasambahay (household helper) (One payment slip per helper, by the 25th of the next month. If they earn under ₱5,000 a month you pay the whole premium; from ₱5,000 they share it); Household employer with a kasambahay (One PhilHealth Payment Slip per helper, by the 25th of the following month; you may pay up to two years ahead).
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 Payment Slip (Household) PhilHealth Slip (Household) now