PhilHealth Letter of Undertaking as Provider of the Expanded Maternity Care Benefits
Fill PhilHealth Letter of Undertaking as Provider of the Expanded Maternity Care Benefits 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: Health Facility Logo, Health Facility Name, Health Facility Address, NAME OF RVP, Address of PhilHealth Regional Office, Name of Facility, address, Antenatal Care (Clinical), Postpartum Care Services (Clinical), Intrapartum Services (NSD), Diagnostic Antenatal Care (DANC) Services, Laboratory Services.
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.
Fill PhilHealth Letter of Undertaking as Provider of the Expanded Maternity Care Benefits now