Professional Documents
Culture Documents
RF-1
PHILIPPINE HEALTH INSURANCE CORPORATION EMPLOYER’S REMITTANCE REPORT
Healthline 441-7444 www.philhealth.gov.ph FOR PHILHEALTH USE
actioncenter@philhealth.gov.ph
Revised February 2014
1
PHILHEALTH NO. 0 2 1 0 0 0 0 1 9 1 4 3 Date Received: __________________
By: ____________________________
Action Taken:
1.
1 3 0 2 5 4 7 1 3 1 4 8 MONTES MATT JOEL ALARDE S
2.
2 1 0 2 5 1 3 9 6 4 3 9 PANGILINAN SARA GERONA S
3.
0 1 0 2 5 7 1 9 8 6 0 5 RAMIREZ KAREEN OLIMAN S
4.
1 2 0 5 0 3 8 6 4 3 7 7 TERCERO CAROLINA CABOTAJE S
5.
0 1 0 5 06 20 55 2 8 VICTORINO JUNEDY ANTHONY E. S
NOTHING FOLLOWS
6.
7.
8.
9.
10 .
12 13 14 15 PREPARED BY:
ACKNOWLEDGEMENT RECEIPT (PAR/POR/TRANSACTION REFERENCE NO.) SUBTOTAL (PS + ES)
______________________
__________ (To be accomplished on every page)
SIGNATURE OVER PRINTED NAME
ACKNOWLEDGEMENT
APPLICABLE PERIOD REMITTED AMOUNT TRANSACTION DATE NO. OF EMPLOYEES ______________________
Indicate Total Number of RECEIPT OFFICIAL DESIGNATION
employees per page GRAND TOTAL (PS + ES)
(To be accomplished on every page) __________________
DATE
16
UNDER THE PENALTY OF THE LAW, I HEREBY ATTEST THAT THE ABOVE INFORMATION PROVIDED HEREIN ARE TRUE AND CORRECT.
PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM