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Er 2

This document is a PhilHealth report listing an employee named Bernadine J. Trinidad. It provides her SSS number, position as a Teacher 1, monthly salary of 27,000 pesos, and employment date of March 31, 2023. The report is being submitted by the employer, the Department of Education in Isabela, and is signed by Belinda R. Matias to enroll the new employee in PhilHealth coverage.

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Bernadine Jacob Trinidad
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1K views2 pages

Er 2

This document is a PhilHealth report listing an employee named Bernadine J. Trinidad. It provides her SSS number, position as a Teacher 1, monthly salary of 27,000 pesos, and employment date of March 31, 2023. The report is being submitted by the employer, the Department of Education in Isabela, and is signed by Belinda R. Matias to enroll the new employee in PhilHealth coverage.

Uploaded by

Bernadine Jacob Trinidad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

PLEASE READ INSTRUCTION AT THE BACK BEFORE ACCOMPLISHING THIS FORM

(CHECK APPLICABLE BOX)


PHILHEALTH INITIAL LIST (Attach to PhilHealth Form Er1)
REPORT OF EMPLOYEE-MEMBERS /
SUBSEQUENT LIST

NAME OF EMPLOYER/FIRM: EMPLOYER NO. 006000010213

ADDRESS: E-MAIL ADDRESS: isabela@deped.gov.ph


PHILHEALTH DATE OF (DO NOT FILL)
EFF. DATE OF PREVIOUS EMPLOYER
SSS/GSIS NAME OF EMPLOYEE POSITION SALARY EMPLOY-
COVERAGE ( IF ANY)
NUMBER MENT
01-025281036-1 BERNADINE J. TRINIDAD TEACHER 1 27,000 MARCH
31, 2023

TOTAL NO. LISTED ABOVE: BELINDA R. MATIAS, Ed.D


PAGE ___ OF ___ SHEETS SIGNATURE OVER PRINTED NAME

TO BE ACCOMPLISHED IN DUPLICATE

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