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PHILHEALTH NO.EMPLOYER TIN
FOR PHILHEALTH USE
COMPLETE EMPLOYER NAMECOMPLETE MAILING ADDRESSTELEPHONE NO.
REVISED JAN 2008
1
Date Received:Action Taken:By:
23EMPLOYER TYPE
PRIVATEGOVERNMENTHOUSEHOLD
4REPORT TYPE
REGULAR RF-1ADDITION TO PREVIOUS RF-1DEDUCTION TO PREVIOUS RF-1
5APPLICABLE PERIOD6
NAME OF EMPLOYEE/S
SURNAMEGIVEN NAME11ACKNOWLEDGEMENT RECEIPT (ME-5/POR/OR/PAR)
PHILHEALTH NO.
SUBTOTAL (PS + ES)
(To be accomplished on every page)
GRAND TOTAL (PS + ES)STATUS12
SIGNATURE OVER PRINTED NAMEOFFICIAL DESIGNATION
DATE
14
PAGEPAGESOF
PLEASE READ INSTRUCTIONS ( FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM
13
PHILIPPINE HEALTH INSURANCE CORPORATION
EMPLOYER’S REMITTANCE REPORT
8
MONTHLYSALARYBRACKET(MSB)
PSES
Signature Over Printed Name
NO.MIDDLE NAME
200
 Republic of the Philippines
(To be accomplished on the last page)
1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.
NHIP PREMIUMCONTRIBUTION
MEMBER STATUS
S-Separated, NE-No Earnings,NH-Newly Hired
CERTIFIED CORRECTREMITTED AMOUNTTRANSACTIONDATEAPPLICABLEPERIODACKNOWLEDGEMENTRECEIPT NO.NO. OFEMPLOYEES7910
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Rose Ann Capito

rf-1 revised 2012 excel format?? pls...

reply04 / 12 / 2012
08 / 26 / 2010This doucment made it onto the Rising List!
allantabamo

anyone could please give me the excel format of RF-1 form revised 2006.

reply06 / 08 / 2010
allantabamo

any could give the excel format of RF-1 Form please.

reply06 / 08 / 2010
fgdc

how to upload in excel

reply03 / 02 / 2010
lehfre

pano ko po e upload ang Rf1 form...ung sa excel file po sna!

reply10 / 12 / 2009
bobbyochea

hi there! pwede pong pahingi ng excel file ng RF1 ng PhilHealth? i-attach niyo na lang po at i-send po sa email ko, bobby.ochea@yahoo.com.. i really need it, please.. thanks!

03 / 23 / 2011
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