Are you an employer of domestic workers such as housekeepers, nannies, and caregivers? If so, there are specific forms that need to be filled out in order to comply with federal law. The Household Employer Form is one such form. This article will discuss what this form involves, why it's important for employers to fill it out correctly and on time if they hire household employees, and how the process works. We’ll also provide resources so that employers can easily understand their obligations related to the form. With proper preparation in place when hiring a new employee or contractor, employers of household workers can make sure they’re in compliance with all required laws and regulations.
| Question | Answer |
|---|---|
| Form Name | Household Employer Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | sss kasambahay registration, how to register kasambahay in sss, kasambahay unified registration form, kasambahay registration form |
Republic of the Philippines
HOUSEHOLD EMPLOYER
UNIFIED REGISTRATION FORM
(Pursuant to R.A. 10361 or the "Batas Kasambahay")
PLEASE READ THE INSTRUCTIONS BELOW BEFORE FILLING OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK OR BLUE INK
.ONLY. (Basahin ang mga Instructions sa ibaba ng Form bago ito sulatan. Isulat ang lahat ng impormasyon sa MALALAKING TITIK at gumamit lamang ng ITIM o ASUL na
.tinta.)
PART I - PLEASE INDICATE YOUR EMPLOYER / MEMBERSHIP NUMBER IF ALREADY REGISTERED
(Paki lagay ang inyong numero sa
PHILHEALTH EMPLOYER NUMBER (PEN)
SSS HOUSEHOLD EMPLOYER ID NUMBER
PART II - A. PERSONAL INFORMATION
NAME |
LAST NAME |
FIRST NAME |
NAME EXTENSION |
MIDDLE NAME |
CHECK IF NO MIDDLE NAME |
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(Apelyido) |
(Pangalan) |
(Ex. Jr. / II) |
(Gitnang Pangalan) |
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gitnang pangalan) |
DATE OF BIRTH (Araw ng Kapanganakan)
Month |
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Day |
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Year |
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SEX (Kasarian)
MALE FEMALE
(Lalake) (Babae)
TAX IDENTIFICATION NUMBER (IF ANY)
ADDRESS |
UNIT/RM./FLR. NO. |
BUILDING NAME |
LOT/BLK./HOUSE NO. |
STREET NAME |
SUBDIVISION |
(Tirahan) |
(Bilang ng Yunit at Palapag) |
(Pangalan ng Gusali) |
(Bilang ng Lote, Bloke, Bahay) |
(Kalye) |
(Subdibisyon) |
BARANGAY/DISTRICT |
MUNICIPALITY/CITY |
PROVINCE/REGION |
(Barangay/Distrito) |
(Munisipyo/Syudad) |
(Probinsya/Rehiyon) |
ZIP CODE
TELEPHONE NUMBER (AREA CODE+TEL. NO.)
MOBILE/CELLPHONE NUMBER
NUMBER OF KASAMBAHAY/S
(Bilang ng Kasambahay)
PART II - B. CERTIFICATION
I hereby certify that the information supplied above are true and correct for the purpose of my registration in the three (3) social security agencies of the Philippine Government, namely,
(Ako ay nagpapatunay na ang aking mga isinaad sa itaas ay totoo at tama na nararapat para ako ay
SIGNATURE OVER PRINTED NAME OF HOUSEHOLD EMPLOYER |
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DATE |
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PART III - TO BE FILLED OUT BY
RECEIVED BY |
PHILHEALTH |
SSS |
EVALUATED BY |
FOR PHILHEALTH USE |
SIGNATURE OVER PRINTED NAME |
DATE & TIME |
BRANCH |
SIGNATURE OVER PRINTED NAME |
DATE & TIME |
PART IV - CERTIFICATION BY RECEIVING AGENCY (If filed through an Authorized Representative)
This is to certify that a Letter of Authorization from the Household Employer was presented and that the signature was verified based on the valid ID presented.
SIGNATURE OVER PRINTED NAME OF |
DATE / TIME |
AUTHORIZED OFFICER OF RECEIVING AGENCY |
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INSTRUCTIONS |
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1.If filed/submitted personally by the Household Employer, no supporting document is required to be submitted.
2.If duly accomplished Form is filed/submitted through an Authorized Representative of the Household Employer, presentation of the following is required:
-Letter of Authorization from Household Employer
-Valid ID of the Household Employer
-Valid ID of the Authorized Representative
3.Update/s or Change/s in the Employer Information should be submitted to each of the 3 Agencies -
THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE