Er1 Writable Form – Fill Out and Use This PDF

The Er1 Writable form is an essential document for employers in the Philippines, required by the Philippine Health Insurance Corporation (PhilHealth) to register employer and employee details. This form captures crucial information such as the name and address of the agency, office, department, business, or firm, contact details, details of the main or head office, the date operations started, number of employees, and the nature of the business or services rendered. To ensure healthcare benefits for your employees, fill out the Er1 form by clicking the button below.

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Er1 Writable Form PDF Details

In the complex landscape of health insurance in the Philippines, the Employer Data Record, commonly known as the Er1 Writable form, plays a pivotal role as a cornerstone document. Managed by the Philippine Health Insurance Corporation, or PhilHealth, this form functions as the initial step for employers in both the government and private sectors to register with the national health insurance program. By furnishing critical details such as the name and address of the business, contact information, the type of business operation, among other specifics, the form ensures a structured pathway for contributions that will underwrite medical expenses for employees. Furthermore, it encompasses a declaration where the employer or a representative attests to the authenticity of the information provided, a step that underscores the legal and ethical responsibility resting on the shoulders of the employer. The procedural process is finalized with an assessment by PhilHealth, indicating a crucial checkpoint in the pursuit of accessible healthcare coverage. This document not only represents a bureaucratic requirement but also embodies the collective responsibility of employers and the state towards safeguarding public health, highlighting a nuanced interface between law, business, and healthcare.

Question	Answer
Form Name	Er1 Writable Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	philhealth er1, er1 form, er1 philhealth, er1

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Republic of the Philippines

P h i l H e a l t h	PH ILIPPINE H EALTH INSURANCE CORPORATION
Em p lo ye r N o . :
	Citystate Centre 709 Shaw Boulevard, Pasig City
		EMPLOYER DATA
	Healthline 637-9999 www.philhealth.gov.ph
		RECORD


1. Nam e of Agen cy/ Office/ Departm en t (for Gov’t . Sector)/ Busin ess/ Firm / Em ployer (for private		TIN
Sector)

2. Address of Agen cy/ Office/ Departm en t/ Busin ess/ Firm / Em ployer

2a. Tel. No.

3. E-Mail Address

3a. Postal Code

4 . If Region al/ Bran ch Office, State th e

n am e an d address of Main / H ead Office

4a. Main / H ead Office/ Em ployer

4b. Date Operation Started

4c. No. of Em ployees

5. Services Ren dered/ Nature of Busin ess/ Operation (for Private Sector)


6 . Type of Agen cy (For Gov’t Sector)			Local	Corporation	Special Project
			Local	Corporation	Special Project
			Nation al	Con stitution al
			Nation al	Con stitution al
			Sin gle Propr ietor	Partn ersh ip	Corporation
(For Private Busin ess/ Operation )			Sin gle Propr ietor	Partn ersh ip	Corporation

	I h ereby certify th at the above data are true an d correct to th e best of m y kn owledge an d belief.

	Date	H ead of Agen cy or Represen tative		Sign ature	Title or Position

		Th i s p o r ti o n i s to b e fi lle d -u p b y P h i lH e a lth

Date Received:

Evaluated by:

Date Evaluation :

Nam e an d Sign ature

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How one can prepare philhealth er1 fill in form part 1

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Part # 2 for filling out philhealth er1 fill in form

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Er1 Writable Form – Fill Out and Use This PDF

Er1 Writable Form PDF Details

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