Er1 Writable Form PDF Details

In today's digital age, there is a growing trend of people shunning the traditional paper-based mediums in favor of electronic formats. While this shift has many benefits, there are certain instances where a physical document is still the preferred option. One such case is when you need to provide a writable form to someone. For example, if you need to collect information from someone for a project or if you want them to sign a contract, having a writable form on hand is much more efficient than trying to type out the information or track down a pen and paper. Thankfully, with modern technology, it's easy to create your own writable forms without any special equipment or software. In this article, we'll show you how to do just that.

QuestionAnswer
Form NameEr1 Writable Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesphilhealth er1, er1 form, er1 philhealth, er1

Form Preview Example

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

 

 

 

 

 

 

 

 

 

 

 

 

Nation al

 

Con stitution al

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sin gle Propr ietor

 

Partn ersh ip

 

Corporation

(For Private Busin ess/ Operation )

 

 

 

 

 

 

 

 

 

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

2. Once your current task is complete, take the next step – fill out all of these fields - Date Received, Evaluated by, Date Evaluation, Th is p o rtio n is to b e fille d, and Nam e and Sign ature with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Part # 2 for filling out philhealth er1 fill in form

It's easy to get it wrong when filling out your Th is p o rtio n is to b e fille d, hence make sure you take another look prior to when you finalize the form.

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