New Joiner Kit

NAME:

SSS #:

TAX ID #: START DATE:

PHILHEALTH #:
PAG-IBIG #: DATE OF NEO:
(Permanent) Joining Formalities
 Table of Contents

Reminders
Bring your New Joiner Kit
on your first day of work.

Bring all applicable forms already

filled out on your hire date. This is
Table of Contents necessary considering the short time
available to fill out forms on Day 1.
Summary of Documents…………………………………………….3
All pre-employment requirements
Forms for Freshers and Employees should be submitted on the first day
Without Government ID Numbers………………………………….4 (exceptions are provided for Certificate
Of Employment (COE) and Bureau of
Forms for Employees with Existing Internal Revenue (BIR) 2316).
Government ID Numbers…………………………………………...5
Ensure that your government numbers
Forms for All Employees are complete on your first day
of joining.
1. Bureau of Internal Revenue (BIR) Form 1902…………………6 - 8
2. Bureau of Internal Revenue (BIR) Form 1905…………………9 -12
3. E-4 (Social Security System Member Data Change Where can I secure
Request)…………………………………..………………………13 - 17 the government ID numbers?
4. MCIF (PAG-IBIG Member’s Change of Information)…………18 - 20
5. PMRF (Philhealth Membership Registration Form)…………..21 - 23
6. Tax Waiver………………………………………………………...24 - 25 TIN SSS
7. Generali……………………………………………………………26 - 27
At the nearest At the nearest
Bank Account Opening…………………………………………….....28 - 33
BIR office SSS office

HDMF PhilHealth

Apply online @ At the nearest

www.pagibigfund.gov.ph PhilHealth office

2 / OGS New Employee Orientation

Summary of Documents
Welcome to Optum Global Solutions! We are glad to have you onboard!
This document will serve as your guide in accomplishing the new joiner forms provided to you during your job offer. We
request you to go through the forms and fill-out all the required documents prior to your New Employee Orientation. All the
forms will be collected on your joining date. For Manila and Cebu hires please ensure that all applicable forms are signed
and submitted to the HR Benefits Dropbox located in each site. While for all hires outside of Manila and Cebu, please reach
out via HR Ops Mailbox (phlhroperations@uhg.com).
Day 1 Forms
These are the forms that need to be submitted on Day 1. Please fill them out prior to the session.
Form Name What is this form for?
Attestation for non-
Tax Waiver (page 24- submission of Bureau of
25) Internal Revenue (BIR)
Form 2316
Permit issued to all
employees working in
Health Certificate and Quezon City. This is
Occupational Permit mandated by the local
government of Quezon
City
Generali Form (page Enrollment to group life
26-27) and accident insurance
Bureau of Internal
Updating of civil status and
Revenue (BIR) Form
or personal information
1905 (page 9-12)
First-time registration to
Bureau of Internal Bureau of Internal
Revenue (BIR) Form Revenue (BIR) if Tax
1902 (page 6-8) Identification Number (TIN)
is not yet available
Registration to PhilHealth if
number is not yet available
PhilHealth Member
or updating of data
Registration Form
provided during enrollment
(PMRF) (page 21-23)
(e.g. status, dependents,
etc.)
Social Security System
(SSS) Member Data Updating of member's data
Change Request (E-4) or correction of previous
(page 13-17) data provided during
Member's Change of enrollment (e.g. status,
Information (MCIF) dependents, etc.)
(page 18-20)
3 / OGS New Employee Orientation
What supporting
Who’s required to
documents need to Where do they need to submit?
submit?
be attached?
All employees without
employers for the
previous year; All
HR Benefits Dropbox or HR Ops Mailbox
employees without None
(phlhroperations@uhg.com)
Bureau of Internal
Revenue (BIR) 2316
available yet
Only new hires
For more details please visit
assigned in Quezon None
https://qceservices.quezoncity.gov.ph/
City
HR Benefits Dropbox or HR Ops Mailbox
All Employees None
(phlhroperations@uhg.com)
Employees who have
Bureau of Internal Revenue (BIR) branch
existing government ID None
near the employee’s residence
numbers
Each of these forms
need one photocopy of
the following:
Fresh graduates and
employees without
1) Philippine Statistics
existing government ID
Authority (PSA) Birth
numbers
Certificate of Employee HR Benefits Dropbox or HR Ops Mailbox
(phlhroperations@uhg.com)
2) Philippine Statistics
Authority (PSA) Birth For Social Security System (SSS):
Certificate of Simple corrections of name, civil status,
Dependents gender log in to your online member
Fresh graduates and account.
3) Philippine Statistics
employees without
Authority (PSA) While for other changes, go to the
existing government ID
Marriage Certificate (if nearest branch office
numbers
married)
* Total of four copies
For employees who for each government
have existing agency
government ID
numbers
Summary of Documents for Freshers

These forms apply only to those without previous employers, or are new graduates.

What supporting
Who’s required to Where do they need to
Form Name What is this form for? documents need to be
submit? submit?
attached?
All employees without
employers for the
Attestation for non-
previous year; All HR Benefits Dropbox or HR
Tax Waiver (page 24- submission of Bureau of
employees without None Ops Mailbox
25) Internal Revenue (BIR)
Bureau of Internal (phlhroperations@uhg.com)
Form 2316
Revenue (BIR) 2316
available yet
HR Benefits Dropbox or HR
Generali Form (page Enrollment to group life
All Employees None Ops Mailbox
26-27) and accident insurance
(phlhroperations@uhg.com)
Each of these forms
need one photocopy of
the following:

1) Philippine Statistics
First-time registration to Authority (PSA) Birth
Fresh graduates and
Bureau of Internal Bureau of Internal Certificate of Employee
employees without
Revenue (BIR) Form Revenue (BIR) if Tax
existing government
1902 (page 6-8) Identification Number 2) Philippine Statistics
ID numbers
(TIN) is not yet available Authority (PSA) Birth
HR Benefits Dropbox or HR
Certificate of
Ops Mailbox
Dependents
(phlhroperations@uhg.com)
3) Philippine Statistics
Authority (PSA)
Registration to Marriage Certificate (if
PhilHealth if number is married)
Fresh graduates and
PhilHealth Member not yet available or
employees without * Total of four copies for
Registration Form updating of data
existing government each government
(PMRF) (page 21-23) provided during
ID numbers agency
enrollment (e.g. status,
dependents, etc.)

For Quezon City New Hires:

Permit issued to all

employees working in
Only new hires
Health Certificate and Quezon City. This is For more details please visit
assigned in Quezon None
Occupational Permit mandated by the local https://qceservices.quezoncity.gov.ph/
City
government of Quezon
City

4 / OGS New Employee Orientation

 e forms apply only to those with previous employers.
Summary of Documents for Tenured Employees

What supporting
What is this form Who’s required to Where do they need to
Form Name documents need to be
for? submit? submit?
attached?

All employees without

Attestation for non-
employers for the previous HR Benefits Dropbox or HR
Tax Waiver submission of Bureau
year; All employees without None Ops Mailbox
(page 24-25) of Internal Revenue
Bureau of Internal Revenue (phlhroperations@uhg.com)
(BIR) Form 2316
(BIR) 2316 available yet
Enrollment to group HR Benefits Dropbox or HR
Generali Form
life and accident All Employees None Ops Mailbox
(page 26-27)
insurance (phlhroperations@uhg.com)
Bureau of
Updating of civil status Employees who have Bureau of Internal Revenue
Internal Revenue
and or personal existing government ID None (BIR) branch near the
(BIR) Form 1905
information numbers employee’s residence
(page 9-12)

PhilHealth Each of these forms

Updating of data need one photocopy of
Member Fresh graduates and
provided during the following:
Registration employees without existing
enrollment (e.g. status,
Form (PMRF) government ID numbers
dependents, etc.) 1) Philippine Statistics
(page 21-23) HR Benefits Dropbox or HR
Authority (PSA) Birth
Ops Mailbox
Certificate of Employee
(phlhroperations@uhg.com)
Social Security 2) Philippine Statistics
For Social Security
System Member Authority (PSA) Birth
System (SSS): Simple
Data Change Certificate of
corrections of name, civil
Request (E-4) Updating of member's Dependents
status, gender log in to your
(page 13-17) data or correction of
For employees who have online member account.
previous data provided 3) Philippine Statistics
existing government ID Authority (PSA)
during enrollment (e.g. While for other changes, go
numbers Marriage Certificate (if
Member's status, dependents, to the nearest branch office
etc.) married)
Change of
Information * Total of four copies for
(MCIF) (page 18- each government
20) agency

For QC New Hires:

Permit issued to all

Health Certificate employees working in
and Quezon City. This is Only new hires assigned in For more details please visit
None
Occupational mandated by the local Quezon City https://qceservices.quezoncity.gov.ph/
Permit government of Quezon
City

5 / OGS New Employee Orientation

 For fresh graduates and employees
BIR Form 1902 without government ID numbers

Attachment:

• 1 photocopy of Philippine
Statistics Authority (PSA)
Birth Certificate of employee
• 1 photocopy of Philippine
Statistics Authority (PSA)
1 2
Birth Certificate of
dependents
• Philippine Statistics Authority 6
(PSA) Marriage Certificate
(if married) 7
8
Required Fields:
9 10
1 Tax Identification Number
2 Taxpayer Type – Local
6 Last, First, Middle Names 11
7 Gender
8 Civil Status 12
9 Birthday
10 Place of Birth 13
11 Mother’s Maiden Name
12 Father’s Name 15
13 Citizenship
15 Complete Address
23 Spouse’s Employment Status
24 Spouse’s Name
25 Spouse’s TIN number
26 Spouse’s Employer’s Name
27 Spouse’s Employer’s TIN
32 Signature Over Printed Name
39 Date Hired

23

24
25

26 27

32

39

6 / OGS New Employee Orientation

(To be filled out by BIR) DLN: _________________
BIR Form No.
Republic of the Philippines
Application for Registration
Department of Finance
Bureau of Internal Revenue 1902
January 2018 (ENCS)
For Individuals Earning Purely Compensation Income
(Local and Alien Employee)
- - - 0 0 0 0 0
New TIN to be issued, if applicable (To be filled out by BIR)
Fill in all applicable white spaces. Write “NA” for those not applicable. Mark all appropriate boxes with an “X”
Part I - Taxpayer/Employee Information
1 PhilSys Number (PSN) 2 Taxpayer Type 3 BIR Registration Date
(To be filled out by BIR) (MM/DD/YYYY)

Local Resident Alien Special Non-Resident Alien

4 Taxpayer Identification Number (TIN) 5 RDO Code
(For Taxpayer with existing TIN)
- - - 0 0 0 0 0 (To be filled out by BIR)

6 Taxpayer’s Name
Last Name First Name

Middle Name Suffix 7 Gender

Male Female

8 Civil Status Single Married Widow/er Legally Separated

9 Date of Birth (MM/DD/YYYY) 10 Place of Birth

11 Mother’s Maiden Name (First Name, Middle Name, Last Name)

12 Father’s Name (First Name, Middle Name, Last Name)

13 Citizenship 14 Other Citizenship

15 Local Residence Address

Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

16 Foreign Address

17 Municipality Code
(To be filled out by BIR) 18 Tax Type ,INCOME1TAX, 19 Form Type ,BIR Form1No. 1700 , 20 ATC II,011.
21 Identification Details (e.g. passport, government issued ID, company ID, etc.)
Type Number Effective Date (MM/DD/YYYY) Expiry Date (MM/DD/YYYY)

Issuer Place/Country of Issue

22 Preferred Contact Type Landline No. Mobile Number

Email Address (required)

Part II - Spouse Information (if applicable)

23 Employment Status of Spouse
Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
24 Spouse Name
Last Name First Name

Middle Name Suffix 25 Spouse TIN

- - - 0 0 0 0 0
26 Spouse Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

27 Spouse Employer’s TIN - - -

 BIR Form No. 1902-page 2
Part III - For Employee with Two or More Employers (Multiple Employments) Within the Calendar Year
28 Type of Multiple Employments
Successive Employments (With previous employer/s within the calendar year)
Concurrent Employments (With two or more employers at the same time within the calendar year)
(If successive, enter previous employer/s; if concurrent, enter secondary employer/s )
Previous and/or Concurrent Employments During the Calendar Year
29A Name of Employer

29B TIN of Employer

30A Name of Employer

30B TIN of Employer

31A Name of Employer

31B TIN of Employer

32 Declaration
I declare under the penalties of perjury that this application, and all its attachments, have been made in good faith, verified by me and to the best of my
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority
thereof. Further, I give my consent to the processing of my information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful
purposes.

________________________________________
Taxpayer(Employee)/Authorized Representative
(Signature over Printed Name)
Part IV – Primary/Current Employer Information
33 Type of Registering Office
0 0 8 - 0 5 6 - 7 83 - 00 0
34 TIN
x Head Office Branch Office
35 RDO Code
04 4
36 Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)
O P T UM G L OB A L SO L U T I O N S P H I L I P P I N E S I N C

37 Employer’s Address
Unit/Room/Floor/Building No. Building Name/Tower
5 th - 1 0 th FL O OR S C I E N C E HU B T OWE R 1
Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

M CK I N L E Y H I L L T A GU I G C I T Y
Province ZIP Code

1 6 3 4
38 Contact Details
Landline Number Fax Number Mobile Number
0 2 85 88 3 2 00
39 Relationship Start Date/Date Employee was Hired 40 Municipality Code (To be filled out by BIR)
(MM/DD/YYYY)
41 Declaration Stamp of BIR Receiving Office
I declare under the penalties of perjury that this application and all its attachments, have been made in good faith, verified by me and Date of Receipt
and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as
amended, and the regulations issued under authority thereof. Further, I give my consent to the processing of my information as
contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

_______________________________________ __________________________
EMPLOYER/AUTHORIZED REPRESENTATIVE Title/Position of Signatory
(Signature over Printed Name)
*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)

Documentary Requirements:

For Local Employee: For Alien Employee:

1. Any identification issued by an authorized government body (e.g. Birth 1. Passport
Certificate, Passport, Driver’s License, etc.) that shows the name, 2. Working Permit or photocopy of duly received Application for Alien
address and birthdate of the applicant. Employment (AEP) by the Department of Labor and Employment
2. Marriage Contract, if applicable. (DOLE)

POSSESSION OF MORE THAN ONE TAXPAYER IDENTIFICATION NUMBER (TIN) IS CRIMINALLY PUNISHABLE PURSUANT TO THE
PROVISIONS OF THE NATIONAL INTERNAL REVENUE CODE OF 1997, AS AMENDED.
9 / OGS New Employee Orientation
(To be filled out by BIR) DLN:

Application for BIR Form No.

Republic of the Philippines
Department of Finance
Bureau of Internal Revenue
Registration Information
Update/Correction/Cancellation
1905
January 2018 (ENCS)
Fill in applicable spaces. Mark all appropriate boxes with an “X”
PART I - TAXPAYER INFORMATION
1 Taxpayer Identification Number (TIN) 2 RDO Code 3 Contact Number
- - -
4 Registered Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

PART II - REASON/DETAILS OF REGISTRATION INFORMATION UPDATE/CORRECTION

5 Replacement/Cancellation of 6 Other Updates
FORM/S REASON/DETAILS
A. Certificate of Registration (COR) Lost/Damaged Closure of Business
(proceed to Number 8)
Change of Accredited Printer as Requested by Change of Civil Status
B. Authority to Print (ATP) Receipts/Invoices the taxpayer (proceed to Number 9)
Correction/Change/Update of Registration of Update of Books of Accounts
C. Tax Clearance Certificate of Liabilities (TCL1) Information (proceed to Number 10)

D. Taxpayer Identification Number (TIN) Card Others (specify) Avail of 8% Income Tax Rate Option
E. Tax Clearance Certificate for Transfer of Property/ies (TCL2)/
Others (specify)
Certificate Authorizing Registration (CAR)
F. Others(specify)
7 Correction/Change/Update of Registration Information
A. CHANGE IN REGISTERED NAME/TRADE NAME
Registered Name Trade/Business Name
New Registered Name/Trade/Business Name
Old
New
B. CHANGE IN REGISTERED ADDRESS (Old RDO) (New RDO)
Transfer within same RDO Transfer to another RDO From To 0 4 4
Unit/Room/Floor/Building No. Building Name/Tower

5 - 1 0 F l r . S c i e n c e H u b T o w e r 1
Lot/Block/Phase/House/Building No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

M c k i n l e y H i l l T a g u i g C i t y
Province ZIP Code
1 6 3 4
C. CHANGE IN ACCOUNTING PERIOD (Applicable to Non-Individual) Accounting Start Month Effectivity Date (MM/DD/YYYY)

From Calendar Period to Fiscal

From One Fiscal Period to Another Fiscal Period

From Fiscal to Calendar Period

D. CHANGE/ADD REGISTERED ACTIVITY/LINE BUSINESS

New Registered Activity/Line of Business Effective Date of Change
(MM/DD/YYYY)

E. CHANGE/ADD FACILITY TYPE/DETAILS (attach additional sheet, if necessary)

Additional/New Facility Facility Type*
Facility Type PP - Place of Production BT - Bus Terminal
Facility Code (check applicable facility type) SP - Storage Place RP - Real Property for
.PP .SP WH .SR GG .BT .RP
. .
Others (specify) WH - Warehouse Lease with No
F SR - Showroom Sales Activity
F GG - Garage
Address of Facility
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House/Building No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

 BIR Form No. 1905 – page2

F. CHANGE/ADD INCENTIVE DETAILS/REGISTRATION

Investment Promotion Agency Number of Years

Legal Basis Start Date (MM/DD/YYYY)

Incentives Granted End Date (MM/DD/YYYY)
Registration/Accreditation No. Registered Activity
From To Tax Regime
Effectivity Date Activity Start Date
(MM/DD/YYYY) (MM/DD/YYYY)

Date Issued (MM/DD/YYYY) Activity End Date

(MM/DD/YYYY)

G. CHANGE/ADD TAX TYPE DETAILS/SUSPEND TAX TYPE/RE-REGISTER TAX TYPE

Form Type ATC Effectivity Date of Change
Suspend/Cancelled Tax Type/s (MM/DD/YYYY)
(to be filled-up by BIR)

Form Type ATC Effectivity Date

Re-register/Added/New Tax Type/s (MM/DD/YYYY)
(to be filled-up by BIR)

H. CHANGE/UPDATE OF CONTACT TYPE

Phone Number Mobile Number Fax Number
Email Address (required)

I. CHANGE/UPDATE OF CONTACT PERSON/AUTHORIZED REPRESENTATIVE

(Last Name, First Name, Middle Name, Suffix)

Position TIN
- - -

J. CHANGE/UPDATE OF NAME OF STOCKHOLDERS/MEMBERS/PARTNERS

(Last Name, First Name, Middle Name, Suffix, If Individual OR Registered Name, if Non Individual)
A
B
C
TIN
A - - -
B - - -
C - - -

8 Closure of Business/Cancellation of Registration

A. CANCELLATION OF TIN
Death As a result of merger/consolidation
Multiple/Identical TIN Others (specify)
Failure to start/commence business (For Non-Individual)
Permanent closure of a branch Effective Date of Cancellation (MM/DD/YYYY)
Dissolution of corporation/partnership

B. DE-REGISTER/CESSATION OF REGISTRATION
Permanent closure of business (head office) of an individual Trade/Business Name

Others (please specify)

Effective Date of Cessation
(MM/DD/YYYY)

9 Change of Civil Status From Single to Married From Married to Single

A. Old Name/Maiden Name (First Name, Middle Name, Last Name, Suffix)

B. New Name/Married Name (First Name, Middle Name, Last Name, Suffix)

C. Spouse Information
Employment Status
of Spouse
Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
Spouse Name (Last Name) (First Name)

(Middle Name) (Suffix) Spouse TIN

0 0 0 0 0
Spouse Employer’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

Spouse Employer’s TIN - - -

 BIR Form No. 1905 – page 3
10 Books of Accounts
Type (Manual or Volume
Type of Books to be Registered Quantity
Loose) From From

Date Registered Permit Number Date Issued (MM/DD/YYYY)

(MM/DD/YYYY)

11 Other Update/Correction (please specify details) For Taxpayer For BIR Use

Effective Date
of Change Approved by:
(MM/DD/YYYY)
REVENUE DISTRICT OFFICER Date
(Signature over Printed Name)
12 Declaration Stamp of BIR Receiving Office
I declare, under the penalties of perjury, that this application has been made in good faith, verified by me and to the best of my and Date of Receipt
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the
regulations issued under authority thereof. Further, I give my consent to the processing of my information as contemplated under the
*Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

____________________________________________________ ______________________
TAXPAYER/AUTHORIZED REPRESENTATIVE/TAX AGENT Title/Position of Signatory
(Signature over Printed Name)

*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)
Documentary Requirements
REPLACEMENT/CANCELLATION E. Change/Add Facility Type/Details
A. Certificate of Registration 1. Appropriate Application for Registration and requirements therein
1. Original Copy of Old Certificate of Registration, for replacement F. Change/Add Incentive Details/Registration
2. Affidavit of Loss, if lost 1. Certificate of Accreditation/Registration from Investment Promotion Agency
3. Proof of payment of Certification Fee and Documentary Stamp Tax - to be submitted before the I. Change/Update of Contact Person/Authorized Representative
issuance of the new Certificate 1. Authorization or Certification issued by Officer enumerated under Section 52 (A) of the Tax Code
B. Authority to Print (ATP) Receipts and Invoices (President or representative and Treasurer or Assistant Treasurer of the Corporation)
1. Original Authority to Print Primary and Secondary Receipts/Invoices J. Change/Update of Stockholders/Members/Partners
2. New Application Form (BIR Form No. 1906), if applicable 1. Amended Articles of Incorporation/Cooperation/Partnership
3. Affidavit of Loss, if lost
C. Tax Clearance Certificate for Tax Liabilities (TCL1) CLOSURE OF BUSINESS/CANCELLATION OF REGISTRATION
1. Affidavit of Loss, if lost 1. Death Certificate, in case of death of an individual;
2. Proof of payment for Certification Fee and Documentary Stamp Tax-to be submitted before the issuance 2. List of ending inventory of goods, supplies, including capital good;
of the new Tax Clearance Certificate 3. Inventory of unused sales invoices/official receipts (SI/OR);
3. TCL1, if for replacement 4. Unused sales invoices/official receipts and all other unutilized accounting forms (e.g., vouchers,
D. TIN Card debit/credit memos, delivery receipts, purchase orders, etc.) including business notices and
1. Affidavit of Loss, if lost permits as well as COR shall be subject for destruction to be witnessed by BIR personnel and
2. Old TIN Card (if replacement is due to damaged card) officials.
3. Marriage Certificate (for change of Family Name)
CHANGE OF CIVIL STATUS
4. SEC Certificate (for Change of Corporate Name) 1. Marriage Contract or Court Order (declaration of nullity of marriage); and
CORRECTION/CHANGE/UPDATE OF REGISTRATION INFORMATION 2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
A. Change in Registered Name/Trade Name
UPDATE OF BOOKS OF ACCOUNT
1. Amended SEC Registration/DTI Certificate; and
1. Photocopy of the first page of the previously approved books
2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
B. Change in Registered Address REGISTRATION OF BOOKS OF ACCOUNTS
FROM OLD RDO A. Manual Books Of Account
1. Inventory List of unused principal and supplementary receipts/invoices for destruction if not to be used 1. New sets of permanently bound books of accounts
in the new RDO or request letter for approval of use of the unused receipts/invoices in new RDO B. Manual Loose Leaf Books Of Accounts
FROM NEW RDO 1. Permit to Use Loose Leaf Books of Accounts;
1. Photocopy of Amended Articles of Incorporation/Partnership bearing the taxpayer’s new principal 2. Permanently bound Loose Leaf Books of Accounts; and
business address and Certificate of Filing of Amended Articles of Incorporation (only for Non-Individual 3. Affidavit attesting the completeness, accuracy and correctness of entries in Books of Accounts
taxpayers); and the number of Loose Leaf used for period covered.
2. Photocopy of Mayor’s Business Permit; or Duly received Application for Mayor’s Business Permit, if the C. Computerized Books Of Accounts
former is still in the process with the LGU; 1. Permit to Use Computerized Accounting System (CAS)/Computerized Books of Accounts
3. Unused principal and supplementary receipts/invoices for re-stamping per approved inventory list by old (CBA) and/or its Components;
RDO; 2. DVDs containing Electronic Books of Accounts and Records. The DVDs should be properly
4. Transfer Commitment Form. authenticated and its labels duly signed by the responsible official(s) of the company who are
C. Change in Accounting Period required to sign the tax returns under the Tax Code, using a permanent marker;
1. Photocopy of the Securities and Exchange Commission (SEC) Certificate of Filing of Amended By-Laws 3. Affidavit attesting the completeness, accuracy and appropriateness of the computerized
showing the change in accounting period. accounting books/records, in accordance with the keeping of books of accounts and records for
D. Change/Add Registered Activity/Line of Business internal revenue tax purposes.
1. Photocopy of Amended Mayor’s Permit or SEC Certificate of Registration if applicable; and
2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
 For updating records; for employees
E-4 (SSS Member Data Change Request) with available government ID
9 / Optum Labs, Inc. New Employee Orientation numbersthout government ID numbers

Required Fields:

A Social Security System Number

B Birthday
C Tax Identification Number
D Full Name
E Present Address A B C
F Contact Information D
G Change of Civil Status
H Updating of Dependents E
I Social Security System Number
J Printed Name F
K Signature
L Date Today

Question
Can I request the company to
deduct my Social Security System
(SSS) Loan via Payroll?
G
Answer
Yes, but not through this form.
Employees have an option to
request continuation of loan by
applying deduction at our AllSec
Payroll Portal.

Please note to get your latest H

Statement of Account and check
with your previous employer if loan
balances have not been deducted
from your last pay. I
J K L

13 / OGS New Employee Orientation

 Republic of the Philippines
SOCIAL SECURITY SYSTEM
E-4 MEMBER DATA CHANGE REQUEST
COV-01215 (09-2015)
THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE. THIS CAN ALSO BE DOWNLOADED THRU THE SSS WEBSITE AT www.sss.gov.ph.

PLEASE READ THE INSTRUCTIONS AT THE BACK BEFORE FILLING OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK
ONLY.
PART I - TO BE FILLED OUT BY MEMBER
A. PERSONAL DATA
SS NUMBER COMMON REFERENCE NUMBER (IF ANY) DATE OF BIRTH (MMDDYYYY) TAX IDENTIFICATION NUMBER (IF ANY)

NAME (LAST NAME) (FIRST NAME) (MIDDLE NAME) (SUFFIX)

ADDRESS (RM./FLR./UNIT NO. & BLDG. NAME) (HOUSE/LOT & BLK NO.) (STREET NAME)

(SUBDIVISION) (BARANGAY/DISTRICT/LOCALITY) (CITY/MUNICIPALITY) (PROVINCE) ZIP CODE

TELEPHONE NUMBER (AREA CODE + TEL. NO.) MOBILE/CELLPHONE NUMBER E-MAIL ADDRESS

FOREIGN ADDRESS (IF APPLICABLE) COUNTRY ZIP CODE

B. DATA CHANGE/CORRECTION/UPDATING
A. CHANGE OF MEMBERSHIP TYPE
FROM TO TO (Option for Prior Registrant Only)
Employed Self-Employed (Please fill-out the details below.) Non-Working Spouse (Please fill-out the details below.)
Voluntary Profession/Business SS No./CRN of Working Spouse

Overseas Filipino Worker Year Profession/Business Started Monthly Income of Working Spouse (P)

Non-Working Spouse (NWS) Monthly Earnings (P) I AGREE WITH MY SPOUSE'S MEMBERSHIP WITH SSS.
Prior Registrant
(A person who registered with the SIGNATURE OVER PRINTED NAME OF WORKING SPOUSE
SSS for the first time as a
prospective employee. )
FROM TO
B. CORRECTION OF NAME
Last Name

First Name
Middle Name
(or change of middle initial to middle name)
Prefix (e.g., "de", "dela", "delos", "del", "Ma." or
"Maria") or Suffix (e.g., Jr., II or III)
Simple Error in Spelling of Name (e.g., "i" to "e"
or "u" to "o" or vice versa; inclusion/ deletion of
space and special characters)
Due to to Re-marriage
C. CORRECTION OF DATE OF BIRTH
D. CORRECTION OF SEX
E. CHANGE OF CIVIL STATUS
(For Female members: Accomplish the FROM and
TO portions, if also requesting for change of name)
Single to Married
Married to Legally Separated

Married to Widowed
Reversion from Married to Single

F. UPDATING OF CONTACT INFORMATION

Address Telephone Number E-mail Address Mobile/Cellphone Number

G. UPDATING OF BANK INFORMATION

Bank Name Bank Branch Account Number
Benefits (Sickness/
Maternity/Partial Disability)

Loans

PESO Fund

H. UPDATING OF MEMBER RECORD STATUS (From "Temporary"

to "Permanent") - please indicate submitted documents
I. UPDATING OF DEPENDENT(S)/BENEFICIARY(IES) (Please check the appropriate box. If more than 3, use other page "Instructions" portion.)
NAME (LAST NAME) (FIRST NAME) (MIDDLE NAME) (SUFFIX) RELATIONSHIP TO MEMBER DATE OF BIRTH (MMDDYYYY)
New/Additional
1. Deletion
New/Additional
2. Deletion
New/Additional
3. Deletion

Perforate
Page 1 of 2 here
 REMINDERS
1. The following required documents should be the original or certified true copy issued by the City or Municipal Civil Registrar or Philippine
Statistics Authority/National Statistics Office:
1.1 Birth Certificate
1.2 Marriage Contract/Marriage Certificate
1.3 Death Certificate
2. All ID cards and/or documents with English translation issued by foreign governments are acceptable.

LIST OF DOCUMENTARY REQUIREMENTS

Always present the original or certified true copy/ies when submitting the photocopy/ies of the required ID card(s) and/or document(s).

A. Change of membership type

1. To Self-Employed - No required documents

2. To Non-Working Spouse - Marriage Contract/Marriage Certificate or a copy of Working Spouse's Member Data Change Request form
(SS Form E-4) duly received by the SSS where the name of the NWS is indicated as the spouse

B./C. Correction of name and/or Correction of date of birth

1. Birth Certificate or Passport.

2. In the absence of the Birth Certificate and Passport, the following are the required ID cards and/or documents:
a. Certificate of Non-Availability of Birth Records from the City or Municipal Civil Registrar or Philippine Statistics Authority/National
Statistics Office or National Archives, for the alleged correct name/date of birth; and
b. Any TWO (2) of the following, both with the correct name and at least one (1) with date of birth:

ID Cards
‒ Driver's License
‒ Firearm License Card issued by Philippine National Police
‒ (PNP)
Government Service Insurance System (GSIS) ID Card
‒ Health or Medical Card
‒ Home Development Mutual Fund (Pag-IBIG) Transaction Card
‒ ID Card issued by Local Government Units (LGUs) (e.g.,
Barangay/Municipality/City)
‒ Overseas Worker Welfare Administration (OWWA) Card
‒ Philippine Health Insurance Corporation (PHIC) ID Card
‒ Postal ID Card
‒ Professional Regulation Commission (PRC) Card
‒ Senior Citizen Card
‒ Taxpayer's Identification Number (TIN) Card
‒ Voter's Identification Card
Documents
‒ Alien Certificate of Registration
‒ Baptismal Certificate or its equivalent (member's)
‒ Birth Certificate/Baptismal Certificate or its equivalent (child/ren's)
‒ Certificate of Licensure/Qualification Documents from Maritime
Industry Authority
‒ Certificate of Muslim Filipino Tribal Affiliation issued by National
Commission on Muslim Filipinos
‒ Court Order granting petition for change of name or date of birth
‒ GSIS Member's Record/Certificate of Membership
‒ Life Insurance Policy
‒ Marriage Contract/Marriage Certificate
‒ National Bureau of Investigation (NBI) Clearance
‒ Pag-IBIG Member's Data Form
‒ PHIC Member's Data Record
‒ Police Clearance
‒ Seaman's Book (Seafarer's Identification and Record book)
‒ Student Permit issued by Land Transportation Office (LTO)
‒ Transcript of Records
‒ Voter's Affidavit/Certificate of Registration

3. Required additional ID cards and/or documents for the following cases:

a. If for correction of date of birth and submitted birth certificate is registered after the 55th birthday - two (2) ID cards and/or documents
in Item 2.b above.

b. If for correction to totally different name/middle name (except if due to naturalization) - Joint Affidavit of two (2) persons
who have personal knowledge of the facts and circumstances on the use of the different name/middle name stating therein that the two
(2) names refer to one (1) and the same person and the reason why the name was used.

4. Required ID cards and/or documents only for the following cases:

a. Correction of name due to naturalization from Filipino citizenship to foreign citizenship or vice-versa - any of the following:
‒ Certificate of Naturalization issued by the Philippine Department of Foreign Affairs
‒ Identification Certificate issued by the Philippine Bureau of Immigration
‒ Any foreign government issued ID cards and/or documents showing the new name (e.g., Passport, Driver's License)

b. Correction of name due to re-marriage - new Marriage Contract/Marriage Certificate and any of the following, whichever is
applicable:
‒ Death Certificate of spouse, if due to death of previously reported spouse
‒ Certificate of Finality of Annulment/Nullity or annotated Marriage Contract/Certificate, if due to annulled or void marriage with
previously reported spouse
‒ Court Order on Declaration of Presumptive Death, if previously reported spouse is presumed dead
‒ Decree of Divorce and Certificate of Naturalization (granted before divorce) or its equivalent, if due to divorce with previously reported
spouse
‒ Certificate of Divorce (OCRG Form No. 102), if due to divorce of Muslim member with previously reported spouse

D. Correction of sex - any of the following, whichever is applicable:

‒ Birth Certificate
‒ Passport
‒ Member's copy of Personal Record (SS Forms E-1, RS-1, OW-1, NW-1) duly received by the SSS where the correct sex is indicated
‒ Court Order granting petititon for correction of sex, if with erroneous entry of sex in Birth Certificate
 C. CERTIFICATION
SS NUMBER
I certify that the information provided in this form are true and correct.

PRINTED NAME SIGNATURE DATE

If member cannot sign, affix fingerprints (please see Instruction no. 5).
Below are the witnesses to fingerprinting:
1)
PRINTED NAME SIGNATURE DATE
ADDRESS & CONTACT NUMBER
2)
PRINTED NAME SIGNATURE DATE
RIGHT THUMB RIGHT INDEX
ADDRESS & CONTACT NUMBER
PART II - TO BE FILLED OUT BY SSS

For Change of Membership Type to For Change of Membership Type to

Self-Employed Non-Working Spouse
Business Code Working Spouse's MSC

Approved MSC Approved MSC of NWS

Start of Payment Start of Payment

Monthly SS Contribution (P) Monthly SS Contribution (P)

RECEIVED BY Perforate here

SIGNATURE OVER PRINTED NAME DATE & TIME BRANCH

PROCESSED BY Perforate BY
ENCODED here

SIGNATURE OVER PRINTED NAME DATE & TIME SIGNATURE OVER PRINTED NAME DATE & TIME
REVIEWED BY APPROVED BY

SIGNATURE OVER PRINTED NAME DATE & TIME SIGNATURE OVER PRINTED NAME DATE & TIME

INSTRUCTIONS

1. Fill out this form in two (2) copies and submit to the nearest SSS branch office together with the required documents. Refer to the
attached "List of Documentary Requirements for Member Data Change Request".

2. Always indicate "N/A" or "Not Applicable", if the required data is not applicable.

3. Present original copy and submit photocopy/ies of the following identification (ID) card/s in filing this form:
a. Filed by member
▪ Social Security (SS) card or Unified Multi-Purpose ID (UMID) card or two (2) ID cards both with signature and one (1) with photo
b. Filed by employer or company representative or household employer
1. SS card or UMID card or two (2) ID cards of the member, both with signature and one (1) with photo; and
2. Additional ID card/s per type of filer
2.a Company ID of the employer-filer, with signature and photo, if filed by employer
2.b Specimen Signature Card (SS Form L-501) of the company representative, if filed by company representative
2.c Two (2) ID cards of the household employer-filer, both with signature and one (1) with photo, if filed by household
employer
4. If member is requesting for updating of contact information (address, telephone number, e-mail address and mobile/cellphone number),
indicate already under Part I-A of the form the new contact information.

5. If member cannot sign, witnesses to fingerprinting shall be as follows:

a. Filed by member
▪ SSS receiving personnel who shall affix his/her signature on the portion provided for in Part I-C.
b. Filed by employer or company representative or household employer
▪ Two (2) witnesses. Both should affix their signatures and indicate their addresses and contact numbers on the portions provided
for in Part I-C. One (1) witness is the member's employer or company representative or household employer himself and the
other one (1) could be any person.

6. If dependents/beneficiaries are more than three (3), please use space provided below.
UPDATING OF DEPENDENT(S)/BENEFICIARY(IES) (Please check the appropriate box. )
NAME (LAST NAME) (FIRST NAME) (MIDDLE NAME) (SUFFIX) RELATIONSHIP TO MEMBER DATE OF BIRTH (MMDDYYYY)
New/Additional
1. Deletion
New/Additional
2. Deletion
New/Additional
3. Deletion
New/Additional
4. Deletion
New/Additional
5. Deletion

Page 2 of 2
E. Change of civil status - any of the following, whichever is applicable
1. From single to married - Marriage Contract/Marriage Certificate
2. From married to legally separated - Decree of Legal Separation
3. From married to widowed
a. Death Certificate of spouse, if due to death of previously reported spouse
b. Court Order on the Declaration of Presumptive Death, if previously reported spouse is presumed dead
4. For reversion from married to single
a. If legally married to previously reported spouse
a.1 Certificate of Finality of Annulment/Nullity or annotated Marriage Contract/Marriage Certificate, if due to annulled or void marriage
with previously reported spouse
a.2 Decree of Divorce and Certificate of Naturalization (granted before divorce) or its equivalent, if due to divorce with previously
reported spouse
a.3 Certificate of Divorce (OCRG Form No. 102), if due to divorce of Muslim member with previously reported spouse
b. If not legally married to previously reported spouse
b.1 Certificate of No Marriage (CENOMAR) from Philippine Statistics Authority/National Statistics Office; and
b.2 Affidavit executed by the member attesting to the fact of the non-existence of marriage between him/her and the previously
reported spouse
F. Updating of contact information - No required documents
G. Updating of bank information - any one (1) of the following (must be single savings or current account only):
‒ Passbook
‒ For ATM, machine-validated deposit slip showing the name and bank account number of member
‒ Any document showing the member's name and bank account number (e.g., print-out of online banking transaction, bank statement)
H. Updating of member record status (from "Temporary" to "Permanent")
1. Birth Certificate or in its absence, any of the following ID cards and/or documents:
‒ Baptismal Certificate or its equivalent
‒ Driver's License
‒ Passport
‒ Professional Regulation Commission (PRC) Card
‒ Seaman's Book (Seafarer's Identification and Record Book)
2. In the absence of the above ID cards and/or documents, any two (2) of the following, both with the correct name and at least one (1) with
date of birth:
‒ Alien Certificate of Registration ‒ Home Development Mutual Fund (Pag-IBIG) Transaction
‒ ATM Card (with cardholder's name) Card/Member's Data Form
‒ Bank Account Passbook ‒ Homeowners Association ID Card
‒ Baptismal Certificate of child/ren or its equivalent ‒ ID Card issued by Local Government Units (LGUs) (e.g.,
‒ Birth Certificate of child/ren Barangay/Municipality/City)
‒ Certificate of Confirmation issued by National Commission on ‒ ID Card issued by professional association recognized by PRC
Indigenous Peoples (formerly Office of Sourthern Cultural ‒ Life Insurance Policy
Community and Office of Northern Cultural Community) ‒ Marriage Contract/Marriage Certificate
‒ Certificate of Licensure/Qualification Documents from ‒ National Bureau of Investigation (NBI) Clearance
Maritime Industry Authority ‒ Overseas Worker Welfare Administration (OWWA) Card
‒ Certificate of Muslim Filipino Tribal Affiliation issued by ‒ Philippine Health Insurance Corporation (PHIC) ID Card/
National Commission on Muslim Filipinos Member's Data Record
‒ Company ID Card ‒ Police Clearance
‒ Court Order granting petition for change of name or date of ‒ Postal ID Card
birth ‒ School ID Card
‒ Credit Card ‒ Seafarer's Registration Certificate issued by Philippine
‒ Firearm License Card issued by Philippine National Police Overseas Employment Administration (POEA)
(PNP) ‒ Senior Citizen Card
‒ Fishworker's License issued by Bureau of Fisheries and ‒ Student Permit issued by Land Transportation Office (LTO)
Aquatic Resources (BFAR) ‒ Taxpayer's Identification Number (TIN) Card
‒ Government Service Insurance System (GSIS) ID Card/ ‒ Transcript of Records
Member's Record/Certificate of Membership ‒ Voter's Identification Card/Affidavit/Certificate of Registration
‒ Health or Medical Card
I. Updating of dependent(s)/beneficiary(ies)
1. For reporting of new/additional dependent(s)/beneficiary(ies)
a. If spouse - Marriage Contract/Marriage Certificate or SS Form E-4 of the spouse duly received by the SSS where the name of the
member requesting the change is reported as the spouse
b. If child/ren - Birth Certificate or Baptismal Certificate or its equivalent or Decree of Adoption
2. For deletion of previously reported dependent(s)/beneficiary(ies)
a. If Spouse - any of the following, whichever is applicable:
‒ Decree of Legal Separation, if legally separated with previously reported spouse
‒ Death Certificate of spouse, if due to death of previously reported spouse
‒ Certificate of Finality of Annulment/Nullity or annotated Marriage Contract/Certificate, if due to annulled or void marriage with
previously reported spouse
‒ Court Order on Declaration of Presumptive Death, if previously reported spouse is presumed dead
‒ Decree of Divorce and Certificate of Naturalization (granted before divorce) or its equivalent, if due to divorce with previously
reported spouse
‒ Certificate of Divorce (OCRG Form No. 102), if due to divorce of Muslim member with previously reported spouse
b. If Parent/s - Death Certificate, if previously reported parent/s is/are already dead
c. If other beneficiary/ies - No required document/s
 For updating records; for employees
PAG-IBIG Member’s Change of Information (MCIF) with available government ID
numbersthout government ID numbers

Required Fields: A
A PAG-IBIG MID Number
B Last, First, Middle Names

The following only if applicable:

C Change/Correction of Name
D Correction of Date of Birth
E Change of Marital status
F Change of Address/Contact Details
B
G Preferred Mailing Address
H Signature over Printed Name
I Date Today
C
Question D
Can I request the company to deduct
my PAG-IBIG loan via payroll?
E
Answer
Yes, but not through this form.
Employees have an option to request
continuation of loan by applying
deduction at our AllSec Payroll Portal. F
Please note to get your latest
Statement of Account and check with
your previous employer if loan
balances have not been deducted
from your last pay.

Question
G
I am a New Hire and I do not have an
HDMF (Home Development Mutual
Fund)/PAG-IBIG number. How do I
request one?

Answer
For new joiners without a PAG-IBIG
number, you can register as a new
member by going to PAG-IBIG
website.
https://www.pagibigfundservices.c
om/pubreg/starter_page.aspx.
Please print the Member’s Data Form
and submit to HR Operations on your H I
joining date

18 / OGS New Employee Orientation

 HQP-PFF-049
(V08, 12/2020)
Pag-IBIG MID NUMBER
MEMBER’S CHANGE OF
INFORMATION FORM (MCIF) HOUSING ACCOUNT NUMBER (if applicable)

INSTRUCTIONS
1. This form shall be accomplished in one (1) copy.
2. Accomplish the applicable portions to be changed/corrected only. Indicate N/A if not applicable.
3. Print all entries in BLOCK/CAPITAL LETTERS.
4. Submit duly accomplished form together with required supporting documents to any Pag-IBIG Branch nearest you.
NOTE: Please submit photocopy of the documents depending on the information to be changed. The original or certified true copy of the said document shall be
presented for authentication.
CHECK THE APPROPRIATE BOX/BOXES AND ACCOMPLISH ONLY THE APPLICABLE PORTION/S TO BE CHANGED/UPDATED
Change of Membership Category Change of Marital Status Updating of Heirs
Change/Correction of Name Change of Address/Contact Details Others (Please specify)
Correction of Date of Birth Change of Employment Details _____________________
LAST NAME FIRST NAME NAME EXTENSION (e.g., Jr., II) MIDDLE NAME

1. CHANGE OF MEMBERSHIP CATEGORY

FROM TO

2. CHANGE/CORRECTION OF NAME (Last Name, First Name, Name Extension, Middle Name)
FROM TO

3. CORRECTION OF DATE OF BIRTH

FROM (mm/dd/yyyy) TO (mm/dd/yyyy)

4. CHANGE OF MARITAL STATUS

FROM TO

FOR MARRIED WOMEN

Use Husband’s Surname Use Maiden Name – Husband’s Surname Retain Maiden Name
SPOUSE Last Name First Name Name Extension Middle Name No Middle Name DATE OF BIRTH (mm/dd/yyyy)
(For Married Status)

5. CHANGE OF ADDRESS/CONTACT DETAILS (Please accomplish portions to be changed only)

PRESENT HOME ADDRESS (Indicate country code if abroad)
Unit/Room No. Floor Bldg. Name Lot No. Block No. Phase No. House No. Street Name Subdivision COUNTRY+AREA CODE TELEPHONE NUMBER

Home

Barangay Municipality/City Province/State/Country (if abroad) Zip Code

Cellphone

PERMANENT HOME ADDRESS

Unit/Room No. Floor Bldg. Name Lot No. Block No. Phase No. House No. Street Name Subdivision Business (Direct Line)

Barangay Municipality/City Province/State/Country (if abroad) Zip Code Business (Trunk Line)

Email Address
PREFERRED MAILING ADDRESS
Present Home Address Permanent Home Address Employer/Business Address
6. CHANGE OF EMPLOYMENT DETAILS
EMPLOYER/BUSINESS NAME OCCUPATION

EMPLOYER/BUSINESS ADDRESS EMPLOYMENT STATUS

Unit/Room No. Floor Bldg. Name Lot No. Block No. Phase No. House No. Street Name Subdivision

Barangay Municipality/City Province/State/Country (if abroad) Zip Code DATE EMPLOYED (Month, Year)

7. UPDATING OF HEIRS (Please use separate sheet, if necessary)

LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME NO MIDDLE NAME RELATIONSHIP DATE OF BIRTH ADDITION/DELETION
(e.g. Jr., II) (Check if applicable only) (mm/dd/yyyy

8. OTHERS (Please specify)

FROM TO

CERTIFICATION
I hereby certify that the information given, and all statements made herein are true and correct. Likewise, I hereby authorize Pag-IBIG Fund to collect record,
organize, update/modify, consult, use, consolidate, block, erase or destruct my personal data as part of my information. I hereby affirm my right to: (a) be
informed; (b) object to processing, (c) access, (d) rectify, suspend or withdraw my personal data; (e) damages; and (f) data portability pursuant to the provision
of R.A. No. 10173 (Data Privacy Act of 2012).

___________________________________ ________________
Signature over Printed Name of Member Date
THIS PORTION IS FOR Pag-IBIG USE ONLY
RECEIVED BY DATE APPROVED BY DATE

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

 HQP-PFF-049
(V08, 12/2020)

CHECKLIST OF REQUIREMENTS
MEMBER FILING THROUGH A REPRESENTATIVE
A. Change of Membership Category A. Change of Membership Category
 Member’s Change of Information Form (MCIF) (1 Original)  Member’s Change of Information Form (MCIF) (1 Original)
 Valid ID acceptable to the Fund (1 Photocopy)  Valid ID of both parties (1 Photocopy)
 Authorization Letter (1 Original)

B. Change/Correction of Name B. Change/Correction of Name

 For Change in name due to Marriage
- MCIF (1 Original)
- Marriage Contract (1 Photocopy) issued by Philippine
Statistics Authority (PSA) or Local Civil Registry
Office (LCRO)
- Valid ID acceptable to the Fund (1 Photocopy)
 For Change in name due to Marriage
- MCIF (1 Original)
- Marriage Contract (1 Photocopy) issued by PSA or
LCRO
- Valid ID of both parties (1 Photocopy)
- Authorization Letter (1 Original)

 For Change in name (for reason other than Marriage)

 For Change in name (for reason other than Marriage)
- MCIF (1 Original)
- Birth Certificate (1 Photocopy) issued by PSA
- Court Order granting petition of change of name
(1 Photocopy) issued by Second Level Regional Trial
Court
- Valid ID acceptable to the Fund (1 Photocopy)
- MCIF (1 Original)
- Birth Certificate (1 Photocopy) issued by PSA
- Court Order granting petition of change of name
(1 Photocopy) issued by Second Level Regional Trial
Court
- Valid ID of both parties (1 Photocopy)
- Authorization Letter (1 Original)

C. Correction of Date of Birth

C. Correction of Date of Birth  MCIF (1 Original)
 MCIF (1 Original)  Birth Certificate (1 Photocopy) issued by PSA
 Birth Certificate (1 Photocopy) issued by PSA  Valid ID of both parties (1 Photocopy)
 Valid ID acceptable to the Fund (1 Photocopy)  Authorization Letter (1 Original)

D. Change of Marital Status

D. Change of Marital Status  For Single to Married
 For Single to Married - MCIF (1 Original)
- MCIF (1 Original) - Marriage Contract (1 Photocopy) issued by PSA or
- Marriage Contract (1 Photocopy) issued by PSA or LCRO
LCRO - Valid ID of both parties (1 Photocopy)
- Valid ID acceptable to the Fund (1 Photocopy) - Authorization Letter (1 Original)

 For Married to Single (legally married to reported spouse)

 For Married to Single (legally married to reported spouse) - MCIF (1 Original)
- MCIF (1 Original) - Court Order (1 Photocopy) issued by Second Level
- Court Order (1 Photocopy) issued by Second Level Regional Trial Court
Regional Trial Court - Valid ID of both parties (1 Photocopy)
- Valid ID acceptable to the Fund (1 Photocopy) - Authorization Letter (1 Original)

 For Married to Single (due to erroneous encoding)

 For Married to Single (due to erroneous encoding) - MCIF (1 Original)
- MCIF (1 Original) - CENOMAR (1 Photocopy) issued by PSA
- CENOMAR (1 Photocopy) issued by PSA - Valid ID of both parties (1 Photocopy)
- Valid ID acceptable to the Fund (1 Photocopy) - Authorization Letter (1 Original)

 For Married to Widowed

 For Married to Widowed - MCIF (1 Original)
- MCIF (1 Original) - Death Certificate of the deceased spouse (1 Photocopy)
- Death Certificate of the deceased spouse issued by PSA or LCRO
(1 Photocopy) issued by PSA or LCRO - Valid ID of both parties (1 Photocopy)
- Valid ID acceptable to the Fund (1 Photocopy) - Authorization Letter (1 Original)

E. Change of Address/Contact Details E. Change of Address/Contact Details

 MCIF (1 Original)  MCIF (1 Original)
 Valid ID acceptable to the Fund (1 Photocopy)  Valid ID of both parties (1 Photocopy)
 Authorization Letter (1 Original)

F. Change of Employment Details F. Change of Employment Details

 MCIF (1 Original)  MCIF (1 Original)
 Valid ID acceptable to the Fund (1 Photocopy)  Valid ID of both parties (1 Photocopy)
 Authorization Letter

G. Updating of Heirs G. Updating of Heirs

 MCIF (1 Original)  MCIF (1 Original)
 Valid ID acceptable to the Fund (1 Photocopy)  Valid ID of both parties (1 Photocopy)
 Authorization Letter (1 Original)

H. Correction of Place of Birth/Mother’s Maiden Name/Gender
(Due to erroneous encoding)
 MCIF (1 Original)
 Birth Certificate (1 Photocopy) issued by PSA
 Valid ID acceptable to the Fund (1 Photocopy)
H. Correction of Place of Birth/Mother’s Maiden Name/Gender
(Due to erroneous encoding)
 MCIF (1 Original)
 Birth Certificate (1 Photocopy) issued by PSA
 Valid ID of both parties (1 Photocopy)
 Authorization Letter (1 Original)

NOTE: In all instances wherein photocopies are submitted, the original or certified true copy must be presented for authentication.
Required Fields:

A Philhealth Identification
Number (only for employees A
with existing Philhealth
number)
B
B Purpose
REGISTRATION if
applying for Philhealth for
the first time
UPDATING/AMENDMENT
for employees with existing C
Philhealth number
D
C Full Name
D Maiden Name (if married)
E Birthday
F Place of Birth E F
G Sex
H Civil Status
I Nationality J
J Tax Identification Number G H I
K Present Address
L Contact Information
M List of Dependents
N Signature over Name L
K
O Date Today

Question
Who can I enroll as
beneficiaries for Philhealth?

Answer M
A. Legitimate spouse who is not
a member
B. Child or children unmarried
and unemployed below 21 years
of age
C. Parents who are 60 years old
and above who is not a member
D. Parents with Permanent
Disability regardless of age

N O

21 / OGS New Employee Orientation

 PMRF
PHILHEALTH MEMBER REGISTRATION FORM
UHC v.1 January 2020

REMINDERS:
PHILHEALTH IDENTIFICATION NUMBER (PIN)
1. Your PhilHealth Identification Number (PIN) is your unique and permanent
PURPOSE:
number.
2. Always use your PIN in all transactions with PhilHealth. REGISTRATION UPDATING/AMENDMENT
3. For Updating/Amendment check the appropriate box and provide details to Preferred KonSulTa Provider
be accomplished and submit corresponding supporting documents.
4. Please read instructions at the back before filling-out this form.

I. PERSONAL DETAILS
NAME NO
MIDDLE MONONYM
LAST NAME FIRST NAME EXTENSION MIDDLE NAME NA ME
(Jr./Sr./III)
(Check i f app li cable onl y)

MEMBER
MOTHER’s
MAIDEN NAME
SPOUSE
(If Married)

DATE OF BIRTH PLACE OF BIRTH (City/Municipality/Province/Country)

(Please indicate country if born outside the Philippines) PHILSYS ID NUMBER (Optional)

m m d d y y y y
SEX CIVIL STATUS CITIZENSHIP TAX PAYE R IDE NTIFICATION NUMBER (TIN) (Optional)
Male Single Annulled FILIPINO FOREIGN NATIONAL
Female Married Widow/er
Legally Separated
DUAL CITIZEN

II. ADDRESS and CONTACT DETAILS

PERMANENT HOME ADDRESS Hom e Phone Number
Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name

(COUN TRY C OD E + AR EA CODE + TEL EPHONE NUM BER)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code
Mobile Number (Required)

MAILING ADDRESS SAME AS ABOVE

Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name Bus iness (Direct Line)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code E-mail Address (Required for OFW)

III. DECLARATION OF DEPENDENTS (Use additional form if necess ary )

DATE OF NO Chec k if
NA ME MIDDLE MONONYM
BIRT H with
LAST NAME FIRST NAME EXTENSION
(Jr./Sr./III)
MIDDLE NAME RELATIONSHIP
(mm-dd-yyyy)
CITIZENSHIP NA ME Per manent
Disa bility
(Check i f app li cable onl y)

IV. MEMBER TYPE

DIRECT CONTRIBUTOR INDIRECT CONTRIBUTOR
Employed Private Kasambahay Family Driver
Listahanan LGU-sponsored
Employed Government Migrant Worker
4Ps/MCCT NGA-sponsored
Professional Practitioner Land-Based Sea-Based
Senior Citizen Private-sponsored
Self-Earning Individual Lifetime Member
Filipinos with Dual Citizenship / Living Abroad PAMANA Person with Disability
Individual
KIA/KIPO PWD ID No. ______________
Sole Proprietor Foreign National
Group Enrollment Scheme PRA SRRV No. _____________________ Bangsamoro/Normalization
____________________ ACR I-Card No. _____________________
For PhilHealth Use only:
PROFESSION: (Except Employed, Lifetime Members and MONTHLY INCOME: PROOF OF INCOME: Point of Service (POS) Financially Incapable
Sea-based Migrant Worker)
Financially Incapable

This form ma y be reproduce d and is not f or sale Continue at the bac k

 V. UPDATING/AMENDMENT
Please check: FROM TO
Change/Correction of Name
(Last Name, First N ame, Name Extension (Jr./Sr./III) Middle Name)

Correction of Date of Birth

Correction of Sex

Change of Civil Status

Updating of Personal Information/Address/

Telephone Number/Mobile Number/e-mail
Address

FOR PHILHEALTH USE ONLY

Under penalty of law, I hereby attest that the information provided, including the documents I
have attached to this form, are true and accurate to the best of my knowledge. I agree and
authorize PhilHealth for the subsequent validation, verification and for other data sharing
RECEIVED BY:
purposes only under the following circumstances:

 As necessary for the proper execution of processes related to the legitimate and Full Name:
declared purpose;
 The use or disclosure is reasonably necessary, required or authorized by or under the ______________________________
law; and,
 Adequate security measures are employed to protect my information. PRO/LHIO/Branch:

_____________________________

Date & Time:

_________________________________________________ _________________
Member’s Signature over Printed Name Date Plea se affix right
______________________________
thumbmark if unable to write

INSTRUCTIONS

1. All information should be written in UPPER CASE/CAPITAL LETTERS. If the information is not applicable, write “N/A.”
2. All fields are mandatory unless indicated as optional. By affixing your signature, you certify the truthfulness and accuracy of all
information provided.
3. A properly accomplished PMRF shall be accompanied by a valid proof of identity for first time registrants, and supporting
documents to establish relationship between member and dependent/s for updating or request for amendment.
4. On the PURPOSE, check the appropriate box if for Registration or for Updating/Amendment of information.
5. Indicate preferred KonSulTa provider near the place of work or residence.
6. For PERSONAL DETAILS, all name entries should follow the format given below. Check the appropriate box if registrant has no
middle name and/or with single name (mononym).

LAST NAME FIRST NAME NAME EXTENSION (Jr./Sr./III) MIDDLE NAME

SANTOS JUAN ANDRES III DELA CRUZ

7. Indicate registrant’s/member’s name as it appears in the birth certificate.

8. The full mother’s maiden name of registrant/member must be indicated as it appears in the birth certificate.
9. Indicate the full name of spouse if registrant/member is married.
10. Indicate the complete permanent and mailing addresses and contact numbers.
11. For updating/amendment, check the appropriate box to be updated/amended and indicate the correct data.
12. For MEMBER TYPE, check the appropriate box which best describes your current membership status.
13. For Direct Contributors, except employed, sea-based migrant workers and lifetime members, indicate the profession, monthly
income and proof of income to be submitted.
14. For Self-earning individuals, Kasambahays and Family Drivers, indicate the actual monthly income in the space provided.
15. In declaring dependents, provide the full name of the living spouse, children below 21 years old, and parents who are 60 years old
and above totally dependent to the member.
16. Dependents with disability shall be registered as principal members in accordance with Republic Act 11228 on mandatory
PhilHealth coverage for all persons with disability (PWD).
17. The registrant must affix his/her signature over printed name (or right thumbmark if unable to write) and indicate the date when the
PMRF was signed.
 Required Fields:

A Date of Joining
B Full Name
C Complete Address
D Tax Identification Number
E Check whatever applies
F Signature over name

24 / OGS New Employee Orientation

 Optum Global Solutions (Philippines), Inc.
th th
5 to 10 Floors Science Hub Tower 1
Block 38 Campus Avenue corner Turin Street
McKinley Hill, Fort Bonifacio,Taguig City
Metro Manila 1634 Philippines

DATE:

TAX WAIVER

I, Mr./Ms. , of legal age, with residence

address at
and with TIN hereby certify that I was not able to submit the required
Certificate of Income Tax on Compensation (BIR Form 2316) from my previous employer as part of
my onboarding requirement due to:

Please check reason:

 No previous employer for the applicable year

 Certificate of Income Tax Withheld on Compensation (BIR Form 2316) is not yet
available from my previous employer. I will submit the same once available.

It was explained to me and I fully understand that upon submission of my Form 2316, Optum Global
Solution (Philippines), Inc. will consolidate the income and taxes as required by Bureau of Internal
Revenue (BIR). Consolidation of such income may result to an increase in withholding tax every
payout.

This is to further certify that any and all taxes due from me as a result of my failure to submit the
above documents to Optum Global Solution (Philippines), Inc. are my sole responsibility and I
hereby undertake to pay all such taxes due directly to the Bureau of Internal Revenue.

I hereby, waive all claims and will protect, indemnify, and hold Optum Global Solution (Philippines),
Inc. free and harmless against all liability in connection with my failure to submit BIR Form 2316
required of me.

Signature over Printed Name

26 / OGS New Employee Orientation
22
 Generali Life Assurance Philippines, Inc.
10th Floor, Petron Mega Plaza
Sen. Gil J. Puyat Ave., Makati City
1227 Philippines
T (632) 000-0000
F (632) 000-0000
www.generali.com

APPLICATION FOR GROUP TERM LIFE INSURANCE

Last Name First Name Middle Name FOR HOME OFFI C E USE ONLY

Date of Birth ( MM/DD/YYYY) Place of Birth Civil Status Sex Policy No.
Certificate No.
Employer/Association/Union Job Title Effective Date
† † Employee
† † Employee and
Date of Employment/Membership Date of Permanent Appointm ent Dependents

FOR GROUP LIFE INSURANCE FOR POLICY WITH DEPENDENT’S COVERAGE

Name of Beneficiary Date of Birth Relationship Name of Dependents Date of Birth Relationship

I HEREBY CERTIFY that the personal data contained herein are true and correct.

APPLICA NT’S SIGNATURE DATE SIGNED

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