Visio Er2
User Manual: ER2
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NAME OF EMPLOYER/FIRM:
PLEASE READ INSTRUCTION AT THE BACK BEFORE ACCOMPLISHING THIS FORM
PHILHEALTH
REPORT OF EMPLOYEE-MEMBERS
(CHECK APPLICABLE BOX)
INITIAL LIST (Attach to PhilHealth Form Er1)
SUBSEQUENT LIST
ADDRESS: E-MAIL ADDRESS:
EMPLOYER NO.
TOTAL NO. LISTED ABOVE:
SIGNATURE OVER PRINTED NAMEPAGE ___ OF ___ SHEETS
TO BE ACCOMPLISHED IN DUPLICATE
PHILHEALTH
SSS/GSIS
NUMBER NAME OF EMPLOYEE POSITION SALARY DATE OF
EMPLOY-
MENT
(DO NOT FILL)
EFF. DATE OF
COVERAGE PREVIOUS EMPLOYER
( IF ANY)
