Download - Philhealth Form
![Page 1: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/1.jpg)
EMP NAME
ADDRESS
PEN EMPLOYER TYPETEL # YEARINCHARGE MONTHPOSITION TYPE OF REPORTEMAIL DATE PREPARED# OF EE'S LAST NAME SUFFIX FIRST NAME
1 DE PAZ RUEL 2 SANTIAGO JEFFREY 3 VELASCO MALOU 4 GAPPI ROMMEL 56789101112131415161718192021222324252627282930313233343536373839404142
![Page 2: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/2.jpg)
4344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192
![Page 3: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/3.jpg)
93949596979899
100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142
![Page 4: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/4.jpg)
143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192
![Page 5: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/5.jpg)
193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242
![Page 6: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/6.jpg)
243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292
![Page 7: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/7.jpg)
293294295296297298299300301302303304305306307308309310311312313314315316317318319320321322323324325326327328329330331332333334335336337338339340341342
![Page 8: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/8.jpg)
343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392
![Page 9: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/9.jpg)
393394395396397398399400401402403404405406407408409410411412413414415416417418419420421422423424425426427428429430431432433434435436437438439440441442
![Page 10: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/10.jpg)
443444445446447448449450451452453454455456457458459460461462463464465466467468469470471472473474475476477478479480481482483484485486487488489490491492
![Page 11: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/11.jpg)
493494495496497498499500501502503504505506507508509510511512513514515516517518519520521522523524525526527528529530531532533534535536537538539540541542
![Page 12: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/12.jpg)
543544545546547548549550551552553554555556557558559560561562563564565566567568569570571572573574575576577578579580581582583584585586587588589590591592
![Page 13: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/13.jpg)
593594595596597598599600601602603604605606607608609610611612613614615616617618619620621622623624625626627628629630631632633634635636637638639640641642
![Page 14: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/14.jpg)
643644645646647648649650651652653654655656657658659660661662663664665666667668669670671672673674675676677678679680681682683684685686687688689690691692
![Page 15: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/15.jpg)
693694695696697698699700701702703704705706707708709710711712713714715716717718719720721722723724725726727728729730731732733734735736737738739740741742
![Page 16: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/16.jpg)
743744745746747748749750751752753754755756757758759760761762763764765766767768769770771772773774775776777778779780781782783784785786787788789790791792
![Page 17: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/17.jpg)
793794795796797798799800801802803804805806807808809810811812813814815816817818819820821822823824825826827828829830831832833834835836837838839840841842
![Page 18: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/18.jpg)
843844845846847848849850851852853854855856857858859860861862863864865866867868869870871872873874875876877878879880881882883884885886887888889890891892
![Page 19: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/19.jpg)
893894895896897898899900901902903904905906907908909910911912913914915916917918919920921922923924925926927928929930931932933934935936937938939940941942
![Page 20: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/20.jpg)
943944945946947948949950951952953954955956957958959960961962963964965966967968969970971972973974975976977978979980981982983984985986987988989990991992
![Page 21: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/21.jpg)
993994995996997998999
1000
![Page 22: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/22.jpg)
EMPLOYEE COUNT 4 SSS NUMBER ME-5 # / OR # TIN AMOUNT PAID
PRIVATE ALLOTED GS DATE PAID2015 PREPARED BY APPLICABLE MONTH
12 DESIGNATION TOTAL RF-1R OVER/UNDER
1/14/2016 3:57PHILHEALTH NO SEX SALARY SB
MIDDLE NAMEIBOJO 0CRUZ 0ALCANTARA 0RAYMUNDO 0
00000000000000000000000000000000000000
DATE OF BIRTH
![Page 23: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/23.jpg)
00000000000000000000000000000000000000000000000000
![Page 24: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/24.jpg)
00000000000000000000000000000000000000000000000000
![Page 25: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/25.jpg)
00000000000000000000000000000000000000000000000000
![Page 26: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/26.jpg)
00000000000000000000000000000000000000000000000000
![Page 27: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/27.jpg)
00000000000000000000000000000000000000000000000000
![Page 28: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/28.jpg)
00000000000000000000000000000000000000000000000000
![Page 29: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/29.jpg)
00000000000000000000000000000000000000000000000000
![Page 30: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/30.jpg)
00000000000000000000000000000000000000000000000000
![Page 31: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/31.jpg)
00000000000000000000000000000000000000000000000000
![Page 32: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/32.jpg)
00000000000000000000000000000000000000000000000000
![Page 33: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/33.jpg)
00000000000000000000000000000000000000000000000000
![Page 34: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/34.jpg)
00000000000000000000000000000000000000000000000000
![Page 35: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/35.jpg)
00000000000000000000000000000000000000000000000000
![Page 36: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/36.jpg)
00000000000000000000000000000000000000000000000000
![Page 37: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/37.jpg)
00000000000000000000000000000000000000000000000000
![Page 38: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/38.jpg)
00000000000000000000000000000000000000000000000000
![Page 39: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/39.jpg)
00000000000000000000000000000000000000000000000000
![Page 40: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/40.jpg)
00000000000000000000000000000000000000000000000000
![Page 41: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/41.jpg)
00000000000000000000000000000000000000000000000000
![Page 42: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/42.jpg)
00000000
![Page 43: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/43.jpg)
TOTAL PS 0.00 LINKSTOTAL ES 0.00NO ALLOTED GS 0.00
DECEMBER TOTAL ARREARS 0.000.00 TOTAL PS & TOTAL ES 0.000.00 TOTAL PS + NO ALLOT 0.00
PS ES ALLOTED REMARKS DATE
0.00 0.00 0.00Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
PRINT OUT RF1SAVE TXT
PRINT OUT RF1aSAVE TXTa
![Page 44: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/44.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 45: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/45.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 46: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/46.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 47: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/47.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 48: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/48.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 49: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/49.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 50: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/50.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 51: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/51.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 52: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/52.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 53: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/53.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 54: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/54.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 55: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/55.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 56: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/56.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 57: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/57.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 58: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/58.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 59: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/59.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 60: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/60.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 61: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/61.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 62: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/62.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 63: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/63.jpg)
Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518Err:518 Err:518 Err:518
![Page 64: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/64.jpg)
REMITTANCE REPORT
000000000000 42015RMEMBERS DE PAZ RUEL I 00000000 000000 000000 000000 000000 000000 000000 SANTIAGO JEFFREY C 00000000 000000 000000 000000 000000 000000 000000 VELASCO MALOU A 00000000 000000 000000 000000 000000 000000 000000 GAPPI ROMMEL R 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 65: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/65.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 66: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/66.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 67: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/67.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 68: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/68.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 69: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/69.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 70: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/70.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 71: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/71.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 72: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/72.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 73: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/73.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 74: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/74.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 75: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/75.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 76: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/76.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 77: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/77.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 78: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/78.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 79: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/79.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 80: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/80.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 81: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/81.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 82: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/82.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 83: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/83.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 84: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/84.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 85: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/85.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 86: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/86.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 87: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/87.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 88: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/88.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 M5-SUMMARY100000000 00000000 12301899 4GRAND TOTAL0000000000
![Page 89: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/89.jpg)
REMITTANCE REPORT
000000000000 42015RMEMBERS DE PAZ RUEL I 00000000 000000 000000 000000 000000 000000 000000 SANTIAGO JEFFREY C 00000000 000000 000000 000000 000000 000000 000000 VELASCO MALOU A 00000000 000000 000000 000000 000000 000000 000000 GAPPI ROMMEL R 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 90: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/90.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 91: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/91.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 92: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/92.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 93: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/93.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 94: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/94.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 95: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/95.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 96: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/96.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 97: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/97.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 98: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/98.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 99: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/99.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 100: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/100.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 101: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/101.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 102: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/102.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 103: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/103.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 104: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/104.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 105: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/105.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 106: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/106.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 107: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/107.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 108: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/108.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 109: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/109.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 110: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/110.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 111: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/111.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 112: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/112.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000
![Page 113: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/113.jpg)
00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 00000000 000000 000000 000000 000000 000000 000000 M5-SUMMARY100000000 00000000 12301899 Err:509GRAND TOTAL0000000000
![Page 114: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/114.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 114 OF 221 PAGES
RF-1 EM THIS PORTION TO BE FILLED UP BY PHILHEALTH
PHILHEALTH NO. 000000000000
EMPLOYER TIN 0
COMPLETE EMPLOYER NAME EMPLOYER TYPE REPORT TYPE
COMPLETE MAILING ADDRESSDECEMBER 2015
TELEPHONE NO. 0 EMAIL ADDRESS 0
EMPLOYEE/S INFORMATION
LAST NAME FIRST NAME MIDDLE NAME PS ES
1 DE PAZ RUEL IBOJO 0 0 2 SANTIAGO JEFFREY CRUZ 0 0 3 VELASCO MALOU ALCANTARA 0 0 4 GAPPI ROMMEL RAYMUNDO 0 0 5 0 0 6 0 0 7 0 0 8 0 0 9 0 0 10 0 0 11 0 0 12 0 0 13 0 0 14 0 0 15 0 0 16 0 0 17 0 0 18 0 0 19 0 0 20 0 0 21 0 0
PHILHEALTH IDENTIFICATION NUMBER (PIN)
PHILHEALTH IDENTIFICATION NUMBER
(PIN)
Fill-out this portion only if declared employee/s has not yet been
issued his/her PIN
NHIP PREMIUM CONTRIBUTION
NAME SUFFIX
DATE OF BIRTH (mm-dd-yyyy)
DATE OF BIRTH (mm-dd-yyyy)
SEX (M/F)
MONTHLY SALARY
BRACKET (MSB)
S-Separated, NE-No Earnings, NH-Newly Hired / Effectivity Date
Revised January2012
1
6
2
7 8 9 10 11
3 4 5
Date Received: ________________________By :________________________
Signature Over Printed Name
Action Taken:
PRIVATE
GOVERNMENT
HOUSEHOLD
REGULAR RF-1ADDITION TO PREVIOUS RF-1DEDUCTION TO PREVIOUS RF-1
![Page 115: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/115.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 115 OF 221 PAGES
22 0 0 23 0 0 24 0 0 25 0 0 26 0 0 27 0 0 28 0 0 29 0 0 30 0 0 31 0 0 32 0 0 33 0 0 34 0 0 35 0 0 36 0 0 37 0 0 38 0 0 39 0 0 40 0 0 41 0 0 42 0 0 43 0 0 44 0 0 45 0 0 46 0 0 47 0 0 48 0 0 49 0 0 50 0 0 51 0 0 52 0 0 53 0 0 54 0 0 55 0 0 56 0 0 57 0 0 58 0 0 59 0 0 60 0 0
![Page 116: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/116.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 116 OF 221 PAGES
61 0 0 62 0 0 63 0 0 64 0 0 65 0 0 66 0 0 67 0 0 68 0 0 69 0 0 70 0 0 71 0 0 72 0 0 73 0 0 74 0 0 75 0 0 76 0 0 77 0 0 78 0 0 79 0 0 80 0 0 81 0 0 82 0 0 83 0 0 84 0 0 85 0 0 86 0 0 87 0 0 88 0 0 89 0 0 90 0 0 91 0 0 92 0 0 93 0 0 94 0 0 95 0 0 96 0 0 97 0 0 98 0 0 99 0 0
![Page 117: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/117.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 117 OF 221 PAGES
100 0 0 101 0 0 102 0 0 103 0 0 104 0 0 105 0 0 106 0 0 107 0 0 108 0 0 109 0 0 110 0 0 111 0 0 112 0 0 113 0 0 114 0 0 115 0 0 116 0 0 117 0 0 118 0 0 119 0 0 120 0 0 121 0 0 122 0 0 123 0 0 124 0 0 125 0 0 126 0 0 127 0 0 128 0 0 129 0 0 130 0 0 131 0 0 132 0 0 133 0 0 134 0 0 135 0 0 136 0 0 137 0 0 138 0 0
![Page 118: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/118.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 118 OF 221 PAGES
139 0 0 140 0 0 141 0 0 142 0 0 143 0 0 144 0 0 145 0 0 146 0 0 147 0 0 148 0 0 149 0 0 150 0 0 151 0 0 152 0 0 153 0 0 154 0 0 155 0 0 156 0 0 157 0 0 158 0 0 159 0 0 160 0 0 161 0 0 162 0 0 163 0 0 164 0 0 165 0 0 166 0 0 167 0 0 168 0 0 169 0 0 170 0 0 171 0 0 172 0 0 173 0 0 174 0 0 175 0 0 176 0 0 177 0 0
![Page 119: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/119.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 119 OF 221 PAGES
178 0 0 179 0 0 180 0 0 181 0 0 182 0 0 183 0 0 184 0 0 185 0 0 186 0 0 187 0 0 188 0 0 189 0 0 190 0 0 191 0 0 192 0 0 193 0 0 194 0 0 195 0 0 196 0 0 197 0 0 198 0 0 199 0 0 200 0 0 201 0 0 202 0 0 203 0 0 204 0 0 205 0 0 206 0 0 207 0 0 208 0 0 209 0 0 210 0 0 211 0 0 212 0 0 213 0 0 214 0 0 215 0 0 216 0 0
![Page 120: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/120.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 120 OF 221 PAGES
217 0 0 218 0 0 219 0 0 220 0 0 221 0 0 222 0 0 223 0 0 224 0 0 225 0 0 226 0 0 227 0 0 228 0 0 229 0 0 230 0 0 231 0 0 232 0 0 233 0 0 234 0 0 235 0 0 236 0 0 237 0 0 238 0 0 239 0 0 240 0 0 241 0 0 242 0 0 243 0 0 244 0 0 245 0 0 246 0 0 247 0 0 248 0 0 249 0 0 250 0 0 251 0 0 252 0 0 253 0 0 254 0 0 255 0 0
![Page 121: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/121.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 121 OF 221 PAGES
256 0 0 257 0 0 258 0 0 259 0 0 260 0 0 261 0 0 262 0 0 263 0 0 264 0 0 265 0 0 266 0 0 267 0 0 268 0 0 269 0 0 270 0 0 271 0 0 272 0 0 273 0 0 274 0 0 275 0 0 276 0 0 277 0 0 278 0 0 279 0 0 280 0 0 281 0 0 282 0 0 283 0 0 284 0 0 285 0 0 286 0 0 287 0 0 288 0 0 289 0 0 290 0 0 291 0 0 292 0 0 293 0 0 294 0 0
![Page 122: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/122.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 122 OF 221 PAGES
295 0 0 296 0 0 297 0 0 298 0 0 299 0 0 300 0 0 301 0 0 302 0 0 303 0 0 304 0 0 305 0 0 306 0 0 307 0 0 308 0 0 309 0 0 310 0 0 311 0 0 312 0 0 313 0 0 314 0 0 315 0 0 316 0 0 317 0 0 318 0 0 319 0 0 320 0 0 321 0 0 322 0 0 323 0 0 324 0 0 325 0 0 326 0 0 327 0 0 328 0 0 329 0 0 330 0 0 331 0 0 332 0 0 333 0 0
![Page 123: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/123.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 123 OF 221 PAGES
334 0 0 335 0 0 336 0 0 337 0 0 338 0 0 339 0 0 340 0 0 341 0 0 342 0 0 343 0 0 344 0 0 345 0 0 346 0 0 347 0 0 348 0 0 349 0 0 350 0 0 351 0 0 352 0 0 353 0 0 354 0 0 355 0 0 356 0 0 357 0 0 358 0 0 359 0 0 360 0 0 361 0 0 362 0 0 363 0 0 364 0 0 365 0 0 366 0 0 367 0 0 368 0 0 369 0 0 370 0 0 371 0 0 372 0 0
![Page 124: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/124.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 124 OF 221 PAGES
373 0 0 374 0 0 375 0 0 376 0 0 377 0 0 378 0 0 379 0 0 380 0 0 381 0 0 382 0 0 383 0 0 384 0 0 385 0 0 386 0 0 387 0 0 388 0 0 389 0 0 390 0 0 391 0 0 392 0 0 393 0 0 394 0 0 395 0 0 396 0 0 397 0 0 398 0 0 399 0 0 400 0 0 401 0 0 402 0 0 403 0 0 404 0 0 405 0 0 406 0 0 407 0 0 408 0 0 409 0 0 410 0 0 411 0 0
![Page 125: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/125.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 125 OF 221 PAGES
412 0 0 413 0 0 414 0 0 415 0 0 416 0 0 417 0 0 418 0 0 419 0 0 420 0 0 421 0 0 422 0 0 423 0 0 424 0 0 425 0 0 426 0 0 427 0 0 428 0 0 429 0 0 430 0 0 431 0 0 432 0 0 433 0 0 434 0 0 435 0 0 436 0 0 437 0 0 438 0 0 439 0 0 440 0 0 441 0 0 442 0 0 443 0 0 444 0 0 445 0 0 446 0 0 447 0 0 448 0 0 449 0 0 450 0 0
![Page 126: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/126.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 126 OF 221 PAGES
451 0 0 452 0 0 453 0 0 454 0 0 455 0 0 456 0 0 457 0 0 458 0 0 459 0 0 460 0 0 461 0 0 462 0 0 463 0 0 464 0 0 465 0 0 466 0 0 467 0 0 468 0 0 469 0 0 470 0 0 471 0 0 472 0 0 473 0 0 474 0 0 475 0 0 476 0 0 477 0 0 478 0 0 479 0 0 480 0 0 481 0 0 482 0 0 483 0 0 484 0 0 485 0 0 486 0 0 487 0 0 488 0 0 489 0 0
![Page 127: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/127.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 127 OF 221 PAGES
490 0 0 491 0 0 492 0 0 493 0 0 494 0 0 495 0 0 496 0 0 497 0 0 498 0 0 499 0 0 500 0 0 501 0 0 502 0 0 503 0 0 504 0 0 505 0 0 506 0 0 507 0 0 508 0 0 509 0 0 510 0 0 511 0 0 512 0 0 513 0 0 514 0 0 515 0 0 516 0 0 517 0 0 518 0 0 519 0 0 520 0 0 521 0 0 522 0 0 523 0 0 524 0 0 525 0 0 526 0 0 527 0 0 528 0 0
![Page 128: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/128.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 128 OF 221 PAGES
529 0 0 530 0 0 531 0 0 532 0 0 533 0 0 534 0 0 535 0 0 536 0 0 537 0 0 538 0 0 539 0 0 540 0 0 541 0 0 542 0 0 543 0 0 544 0 0 545 0 0 546 0 0 547 0 0 548 0 0 549 0 0 550 0 0 551 0 0 552 0 0 553 0 0 554 0 0 555 0 0 556 0 0 557 0 0 558 0 0 559 0 0 560 0 0 561 0 0 562 0 0 563 0 0 564 0 0 565 0 0 566 0 0 567 0 0
![Page 129: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/129.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 129 OF 221 PAGES
568 0 0 569 0 0 570 0 0 571 0 0 572 0 0 573 0 0 574 0 0 575 0 0 576 0 0 577 0 0 578 0 0 579 0 0 580 0 0 581 0 0 582 0 0 583 0 0 584 0 0 585 0 0 586 0 0 587 0 0 588 0 0 589 0 0 590 0 0 591 0 0 592 0 0 593 0 0 594 0 0 595 0 0 596 0 0 597 0 0 598 0 0 599 0 0 600 0 0 601 0 0 602 0 0 603 0 0 604 0 0 605 0 0 606 0 0
![Page 130: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/130.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 130 OF 221 PAGES
607 0 0 608 0 0 609 0 0 610 0 0 611 0 0 612 0 0 613 0 0 614 0 0 615 0 0 616 0 0 617 0 0 618 0 0 619 0 0 620 0 0 621 0 0 622 0 0 623 0 0 624 0 0 625 0 0 626 0 0 627 0 0 628 0 0 629 0 0 630 0 0 631 0 0 632 0 0 633 0 0 634 0 0 635 0 0 636 0 0 637 0 0 638 0 0 639 0 0 640 0 0 641 0 0 642 0 0 643 0 0 644 0 0 645 0 0
![Page 131: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/131.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 131 OF 221 PAGES
646 0 0 647 0 0 648 0 0 649 0 0 650 0 0 651 0 0 652 0 0 653 0 0 654 0 0 655 0 0 656 0 0 657 0 0 658 0 0 659 0 0 660 0 0 661 0 0 662 0 0 663 0 0 664 0 0 665 0 0 666 0 0 667 0 0 668 0 0 669 0 0 670 0 0 671 0 0 672 0 0 673 0 0 674 0 0 675 0 0 676 0 0 677 0 0 678 0 0 679 0 0 680 0 0 681 0 0 682 0 0 683 0 0 684 0 0
![Page 132: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/132.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 132 OF 221 PAGES
685 0 0 686 0 0 687 0 0 688 0 0 689 0 0 690 0 0 691 0 0 692 0 0 693 0 0 694 0 0 695 0 0 696 0 0 697 0 0 698 0 0 699 0 0 700 0 0 701 0 0 702 0 0 703 0 0 704 0 0 705 0 0 706 0 0 707 0 0 708 0 0 709 0 0 710 0 0 711 0 0 712 0 0 713 0 0 714 0 0 715 0 0 716 0 0 717 0 0 718 0 0 719 0 0 720 0 0 721 0 0 722 0 0 723 0 0
![Page 133: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/133.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 133 OF 221 PAGES
724 0 0 725 0 0 726 0 0 727 0 0 728 0 0 729 0 0 730 0 0 731 0 0 732 0 0 733 0 0 734 0 0 735 0 0 736 0 0 737 0 0 738 0 0 739 0 0 740 0 0 741 0 0 742 0 0 743 0 0 744 0 0 745 0 0 746 0 0 747 0 0 748 0 0 749 0 0 750 0 0 751 0 0 752 0 0 753 0 0 754 0 0 755 0 0 756 0 0 757 0 0 758 0 0 759 0 0 760 0 0 761 0 0 762 0 0
![Page 134: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/134.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 134 OF 221 PAGES
763 0 0 764 0 0 765 0 0 766 0 0 767 0 0 768 0 0 769 0 0 770 0 0 771 0 0 772 0 0 773 0 0 774 0 0 775 0 0 776 0 0 777 0 0 778 0 0 779 0 0 780 0 0 781 0 0 782 0 0 783 0 0 784 0 0 785 0 0 786 0 0 787 0 0 788 0 0 789 0 0 790 0 0 791 0 0 792 0 0 793 0 0 794 0 0 795 0 0 796 0 0 797 0 0 798 0 0 799 0 0 800 0 0 801 0 0
![Page 135: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/135.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 135 OF 221 PAGES
802 0 0 803 0 0 804 0 0 805 0 0 806 0 0 807 0 0 808 0 0 809 0 0 810 0 0 811 0 0 812 0 0 813 0 0 814 0 0 815 0 0 816 0 0 817 0 0 818 0 0 819 0 0 820 0 0 821 0 0 822 0 0 823 0 0 824 0 0 825 0 0 826 0 0 827 0 0 828 0 0 829 0 0 830 0 0 831 0 0 832 0 0 833 0 0 834 0 0 835 0 0 836 0 0 837 0 0 838 0 0 839 0 0 840 0 0
![Page 136: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/136.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 136 OF 221 PAGES
841 0 0 842 0 0 843 0 0 844 0 0 845 0 0 846 0 0 847 0 0 848 0 0 849 0 0 850 0 0 851 0 0 852 0 0 853 0 0 854 0 0 855 0 0 856 0 0 857 0 0 858 0 0 859 0 0 860 0 0 861 0 0 862 0 0 863 0 0 864 0 0 865 0 0 866 0 0 867 0 0 868 0 0 869 0 0 870 0 0 871 0 0 872 0 0 873 0 0 874 0 0 875 0 0 876 0 0 877 0 0 878 0 0 879 0 0
![Page 137: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/137.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 137 OF 221 PAGES
880 0 0 881 0 0 882 0 0 883 0 0 884 0 0 885 0 0 886 0 0 887 0 0 888 0 0 889 0 0 890 0 0 891 0 0 892 0 0 893 0 0 894 0 0 895 0 0 896 0 0 897 0 0 898 0 0 899 0 0 900 0 0 901 0 0 902 0 0 903 0 0 904 0 0 905 0 0 906 0 0 907 0 0 908 0 0 909 0 0 910 0 0 911 0 0 912 0 0 913 0 0 914 0 0 915 0 0 916 0 0 917 0 0 918 0 0
![Page 138: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/138.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 138 OF 221 PAGES
919 0 0 920 0 0 921 0 0 922 0 0 923 0 0 924 0 0 925 0 0 926 0 0 927 0 0 928 0 0 929 0 0 930 0 0 931 0 0 932 0 0 933 0 0 934 0 0 935 0 0 936 0 0 937 0 0 938 0 0 939 0 0 940 0 0 941 0 0 942 0 0 943 0 0 944 0 0 945 0 0 946 0 0 947 0 0 948 0 0 949 0 0 950 0 0 951 0 0 952 0 0 953 0 0 954 0 0 955 0 0 956 0 0 957 0 0
![Page 139: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/139.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 139 OF 221 PAGES
958 0 0 959 0 0 960 0 0 961 0 0 962 0 0 963 0 0 964 0 0 965 0 0 966 0 0 967 0 0 968 0 0 969 0 0 970 0 0 971 0 0 972 0 0 973 0 0 974 0 0 975 0 0 976 0 0 977 0 0 978 0 0 979 0 0 980 0 0 981 0 0 982 0 0 983 0 0 984 0 0 985 0 0 986 0 0 987 0 0 988 0 0 989 0 0 990 0 0 991 0 0 992 0 0 993 0 0 994 0 0 995 0 0 996 0 0
![Page 140: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/140.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 140 OF 221 PAGES
997 0 0 998 0 0 999 0 0 1000 0 0
ACKNOWLEDGEMENT RECEIPT (PAR/POR/TRANSACTION REFERENCE NO.)
GRAND TOTAL (PS+ES) 0.00 0.00
4 APPLICABLE PERIOD REMITTED AMOUNT ACKNOWLEDGEMENT RECEIPT TRANSACTION DATE
DECEMBER 0.00 0 (To be accomplished on every page) 0.00 1/14/2016 3:57
UNDER THE PENALTY OF THE LAW, I HEREBY ATTEST THAT THE ABOVE INFORMATIONS PROVIDED HEREIN ARE TRUE AND CORRECT.
Signature over printed name Official Designation Date
Indicate Total Number of employees per page
14 1512
16
13SIGNATURE OVER PRINTED NAME
OFFICIAL DESIGNATION
DATE
![Page 141: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/141.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 141 OF 221 PAGES
THIS PORTION TO BE FILLED UP BY PHILHEALTH
DECEMBER 2015
EMPLOYEE STATUS
APPLICABLE PERIOD
S-Separated, NE-No Earnings, NH-Newly Hired / Effectivity Date
11
Action Taken:
![Page 142: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/142.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 142 OF 221 PAGES
![Page 143: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/143.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 143 OF 221 PAGES
![Page 144: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/144.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 144 OF 221 PAGES
![Page 145: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/145.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 145 OF 221 PAGES
![Page 146: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/146.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 146 OF 221 PAGES
![Page 147: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/147.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 147 OF 221 PAGES
![Page 148: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/148.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 148 OF 221 PAGES
![Page 149: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/149.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 149 OF 221 PAGES
![Page 150: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/150.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 150 OF 221 PAGES
![Page 151: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/151.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 151 OF 221 PAGES
![Page 152: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/152.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 152 OF 221 PAGES
![Page 153: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/153.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 153 OF 221 PAGES
![Page 154: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/154.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 154 OF 221 PAGES
![Page 155: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/155.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 155 OF 221 PAGES
![Page 156: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/156.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 156 OF 221 PAGES
![Page 157: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/157.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 157 OF 221 PAGES
![Page 158: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/158.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 158 OF 221 PAGES
![Page 159: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/159.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 159 OF 221 PAGES
![Page 160: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/160.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 160 OF 221 PAGES
![Page 161: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/161.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 161 OF 221 PAGES
![Page 162: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/162.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 162 OF 221 PAGES
![Page 163: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/163.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 163 OF 221 PAGES
![Page 164: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/164.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 164 OF 221 PAGES
![Page 165: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/165.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 165 OF 221 PAGES
![Page 166: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/166.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 166 OF 221 PAGES
![Page 167: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/167.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 167 OF 221 PAGES
1/14/2016 3:57
UNDER THE PENALTY OF THE LAW, I HEREBY ATTEST THAT THE ABOVE INFORMATIONS PROVIDED HEREIN ARE TRUE AND CORRECT.
SIGNATURE OVER PRINTED NAME
OFFICIAL DESIGNATION
DATE
![Page 168: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/168.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 168 OF 221 PAGES
RF-1 EMPL THIS PORTION TO BE FILLED UP BY PHILHEALTH
PHILHEALTH NO. 000000000000
EMPLOYER TIN 0
COMPLETE EMPLOYER NAME EMPLOYER TYPE REPORT TYPE
COMPLETE MAILING ADDRESSDECEMBER 2015
TELEPHONE NO. 0 EMAIL ADDRESS 0
EMPLOYEE/S INFORMATION
LAST NAME FIRST NAME MIDDLE NAME PS ES
1 DE PAZ RUEL IBOJO 0 0 2 SANTIAGO JEFFREY CRUZ 0 0 3 VELASCO MALOU ALCANTARA 0 0 4 GAPPI ROMMEL RAYMUNDO 0 0 5 0 0 6 0 0 7 0 0 8 0 0 9 0 0 10 0 0 11 0 0 12 0 0 13 0 0 14 0 0 15 0 0 16 0 0 17 0 0 18 0 0 19 0 0 20 0 0 21 0 0
PHILHEALTH IDENTIFICATION NUMBER (PIN)
PHILHEALTH IDENTIFICATION NUMBER
(PIN)
Fill-out this portion only if declared employee/s has not yet been
issued his/her PIN
NHIP PREMIUM CONTRIBUTION
NAME SUFFIX
DATE OF BIRTH (mm-dd-yyyy)
DATE OF BIRTH (mm-dd-yyyy)
SEX (M/F)
MONTHLY SALARY
BRACKET (MSB)
S-Separated, NE-No Earnings, NH-Newly Hired / Effectivity Date
Revised January2012
1
6
2
7 8 9 10 11
3 4 5
Date Received: ________________________By :________________________
Signature Over Printed Name
Action Taken:
PRIVATE
GOVERNMENT
HOUSEHOLD
REGULAR RF-1ADDITION TO PREVIOUS RF-1DEDUCTION TO PREVIOUS RF-1
![Page 169: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/169.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 169 OF 221 PAGES
22 0 0 23 0 0 24 0 0 25 0 0 26 0 0 27 0 0 28 0 0 29 0 0 30 0 0 31 0 0 32 0 0 33 0 0 34 0 0 35 0 0 36 0 0 37 0 0 38 0 0 39 0 0 40 0 0 41 0 0 42 0 0 43 0 0 44 0 0 45 0 0 46 0 0 47 0 0 48 0 0 49 0 0 50 0 0 51 0 0 52 0 0 53 0 0 54 0 0 55 0 0 56 0 0 57 0 0 58 0 0 59 0 0 60 0 0
![Page 170: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/170.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 170 OF 221 PAGES
61 0 0 62 0 0 63 0 0 64 0 0 65 0 0 66 0 0 67 0 0 68 0 0 69 0 0 70 0 0 71 0 0 72 0 0 73 0 0 74 0 0 75 0 0 76 0 0 77 0 0 78 0 0 79 0 0 80 0 0 81 0 0 82 0 0 83 0 0 84 0 0 85 0 0 86 0 0 87 0 0 88 0 0 89 0 0 90 0 0 91 0 0 92 0 0 93 0 0 94 0 0 95 0 0 96 0 0 97 0 0 98 0 0 99 0 0
![Page 171: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/171.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 171 OF 221 PAGES
100 0 0 101 0 0 102 0 0 103 0 0 104 0 0 105 0 0 106 0 0 107 0 0 108 0 0 109 0 0 110 0 0 111 0 0 112 0 0 113 0 0 114 0 0 115 0 0 116 0 0 117 0 0 118 0 0 119 0 0 120 0 0 121 0 0 122 0 0 123 0 0 124 0 0 125 0 0 126 0 0 127 0 0 128 0 0 129 0 0 130 0 0 131 0 0 132 0 0 133 0 0 134 0 0 135 0 0 136 0 0 137 0 0 138 0 0
![Page 172: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/172.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 172 OF 221 PAGES
139 0 0 140 0 0 141 0 0 142 0 0 143 0 0 144 0 0 145 0 0 146 0 0 147 0 0 148 0 0 149 0 0 150 0 0 151 0 0 152 0 0 153 0 0 154 0 0 155 0 0 156 0 0 157 0 0 158 0 0 159 0 0 160 0 0 161 0 0 162 0 0 163 0 0 164 0 0 165 0 0 166 0 0 167 0 0 168 0 0 169 0 0 170 0 0 171 0 0 172 0 0 173 0 0 174 0 0 175 0 0 176 0 0 177 0 0
![Page 173: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/173.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 173 OF 221 PAGES
178 0 0 179 0 0 180 0 0 181 0 0 182 0 0 183 0 0 184 0 0 185 0 0 186 0 0 187 0 0 188 0 0 189 0 0 190 0 0 191 0 0 192 0 0 193 0 0 194 0 0 195 0 0 196 0 0 197 0 0 198 0 0 199 0 0 200 0 0 201 0 0 202 0 0 203 0 0 204 0 0 205 0 0 206 0 0 207 0 0 208 0 0 209 0 0 210 0 0 211 0 0 212 0 0 213 0 0 214 0 0 215 0 0 216 0 0
![Page 174: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/174.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 174 OF 221 PAGES
217 0 0 218 0 0 219 0 0 220 0 0 221 0 0 222 0 0 223 0 0 224 0 0 225 0 0 226 0 0 227 0 0 228 0 0 229 0 0 230 0 0 231 0 0 232 0 0 233 0 0 234 0 0 235 0 0 236 0 0 237 0 0 238 0 0 239 0 0 240 0 0 241 0 0 242 0 0 243 0 0 244 0 0 245 0 0 246 0 0 247 0 0 248 0 0 249 0 0 250 0 0 251 0 0 252 0 0 253 0 0 254 0 0 255 0 0
![Page 175: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/175.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 175 OF 221 PAGES
256 0 0 257 0 0 258 0 0 259 0 0 260 0 0 261 0 0 262 0 0 263 0 0 264 0 0 265 0 0 266 0 0 267 0 0 268 0 0 269 0 0 270 0 0 271 0 0 272 0 0 273 0 0 274 0 0 275 0 0 276 0 0 277 0 0 278 0 0 279 0 0 280 0 0 281 0 0 282 0 0 283 0 0 284 0 0 285 0 0 286 0 0 287 0 0 288 0 0 289 0 0 290 0 0 291 0 0 292 0 0 293 0 0 294 0 0
![Page 176: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/176.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 176 OF 221 PAGES
295 0 0 296 0 0 297 0 0 298 0 0 299 0 0 300 0 0 301 0 0 302 0 0 303 0 0 304 0 0 305 0 0 306 0 0 307 0 0 308 0 0 309 0 0 310 0 0 311 0 0 312 0 0 313 0 0 314 0 0 315 0 0 316 0 0 317 0 0 318 0 0 319 0 0 320 0 0 321 0 0 322 0 0 323 0 0 324 0 0 325 0 0 326 0 0 327 0 0 328 0 0 329 0 0 330 0 0 331 0 0 332 0 0 333 0 0
![Page 177: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/177.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 177 OF 221 PAGES
334 0 0 335 0 0 336 0 0 337 0 0 338 0 0 339 0 0 340 0 0 341 0 0 342 0 0 343 0 0 344 0 0 345 0 0 346 0 0 347 0 0 348 0 0 349 0 0 350 0 0 351 0 0 352 0 0 353 0 0 354 0 0 355 0 0 356 0 0 357 0 0 358 0 0 359 0 0 360 0 0 361 0 0 362 0 0 363 0 0 364 0 0 365 0 0 366 0 0 367 0 0 368 0 0 369 0 0 370 0 0 371 0 0 372 0 0
![Page 178: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/178.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 178 OF 221 PAGES
373 0 0 374 0 0 375 0 0 376 0 0 377 0 0 378 0 0 379 0 0 380 0 0 381 0 0 382 0 0 383 0 0 384 0 0 385 0 0 386 0 0 387 0 0 388 0 0 389 0 0 390 0 0 391 0 0 392 0 0 393 0 0 394 0 0 395 0 0 396 0 0 397 0 0 398 0 0 399 0 0 400 0 0 401 0 0 402 0 0 403 0 0 404 0 0 405 0 0 406 0 0 407 0 0 408 0 0 409 0 0 410 0 0 411 0 0
![Page 179: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/179.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 179 OF 221 PAGES
412 0 0 413 0 0 414 0 0 415 0 0 416 0 0 417 0 0 418 0 0 419 0 0 420 0 0 421 0 0 422 0 0 423 0 0 424 0 0 425 0 0 426 0 0 427 0 0 428 0 0 429 0 0 430 0 0 431 0 0 432 0 0 433 0 0 434 0 0 435 0 0 436 0 0 437 0 0 438 0 0 439 0 0 440 0 0 441 0 0 442 0 0 443 0 0 444 0 0 445 0 0 446 0 0 447 0 0 448 0 0 449 0 0 450 0 0
![Page 180: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/180.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 180 OF 221 PAGES
451 0 0 452 0 0 453 0 0 454 0 0 455 0 0 456 0 0 457 0 0 458 0 0 459 0 0 460 0 0 461 0 0 462 0 0 463 0 0 464 0 0 465 0 0 466 0 0 467 0 0 468 0 0 469 0 0 470 0 0 471 0 0 472 0 0 473 0 0 474 0 0 475 0 0 476 0 0 477 0 0 478 0 0 479 0 0 480 0 0 481 0 0 482 0 0 483 0 0 484 0 0 485 0 0 486 0 0 487 0 0 488 0 0 489 0 0
![Page 181: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/181.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 181 OF 221 PAGES
490 0 0 491 0 0 492 0 0 493 0 0 494 0 0 495 0 0 496 0 0 497 0 0 498 0 0 499 0 0 500 0 0 501 0 0 502 0 0 503 0 0 504 0 0 505 0 0 506 0 0 507 0 0 508 0 0 509 0 0 510 0 0 511 0 0 512 0 0 513 0 0 514 0 0 515 0 0 516 0 0 517 0 0 518 0 0 519 0 0 520 0 0 521 0 0 522 0 0 523 0 0 524 0 0 525 0 0 526 0 0 527 0 0 528 0 0
![Page 182: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/182.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 182 OF 221 PAGES
529 0 0 530 0 0 531 0 0 532 0 0 533 0 0 534 0 0 535 0 0 536 0 0 537 0 0 538 0 0 539 0 0 540 0 0 541 0 0 542 0 0 543 0 0 544 0 0 545 0 0 546 0 0 547 0 0 548 0 0 549 0 0 550 0 0 551 0 0 552 0 0 553 0 0 554 0 0 555 0 0 556 0 0 557 0 0 558 0 0 559 0 0 560 0 0 561 0 0 562 0 0 563 0 0 564 0 0 565 0 0 566 0 0 567 0 0
![Page 183: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/183.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 183 OF 221 PAGES
568 0 0 569 0 0 570 0 0 571 0 0 572 0 0 573 0 0 574 0 0 575 0 0 576 0 0 577 0 0 578 0 0 579 0 0 580 0 0 581 0 0 582 0 0 583 0 0 584 0 0 585 0 0 586 0 0 587 0 0 588 0 0 589 0 0 590 0 0 591 0 0 592 0 0 593 0 0 594 0 0 595 0 0 596 0 0 597 0 0 598 0 0 599 0 0 600 0 0 601 0 0 602 0 0 603 0 0 604 0 0 605 0 0 606 0 0
![Page 184: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/184.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 184 OF 221 PAGES
607 0 0 608 0 0 609 0 0 610 0 0 611 0 0 612 0 0 613 0 0 614 0 0 615 0 0 616 0 0 617 0 0 618 0 0 619 0 0 620 0 0 621 0 0 622 0 0 623 0 0 624 0 0 625 0 0 626 0 0 627 0 0 628 0 0 629 0 0 630 0 0 631 0 0 632 0 0 633 0 0 634 0 0 635 0 0 636 0 0 637 0 0 638 0 0 639 0 0 640 0 0 641 0 0 642 0 0 643 0 0 644 0 0 645 0 0
![Page 185: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/185.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 185 OF 221 PAGES
646 0 0 647 0 0 648 0 0 649 0 0 650 0 0 651 0 0 652 0 0 653 0 0 654 0 0 655 0 0 656 0 0 657 0 0 658 0 0 659 0 0 660 0 0 661 0 0 662 0 0 663 0 0 664 0 0 665 0 0 666 0 0 667 0 0 668 0 0 669 0 0 670 0 0 671 0 0 672 0 0 673 0 0 674 0 0 675 0 0 676 0 0 677 0 0 678 0 0 679 0 0 680 0 0 681 0 0 682 0 0 683 0 0 684 0 0
![Page 186: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/186.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 186 OF 221 PAGES
685 0 0 686 0 0 687 0 0 688 0 0 689 0 0 690 0 0 691 0 0 692 0 0 693 0 0 694 0 0 695 0 0 696 0 0 697 0 0 698 0 0 699 0 0 700 0 0 701 0 0 702 0 0 703 0 0 704 0 0 705 0 0 706 0 0 707 0 0 708 0 0 709 0 0 710 0 0 711 0 0 712 0 0 713 0 0 714 0 0 715 0 0 716 0 0 717 0 0 718 0 0 719 0 0 720 0 0 721 0 0 722 0 0 723 0 0
![Page 187: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/187.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 187 OF 221 PAGES
724 0 0 725 0 0 726 0 0 727 0 0 728 0 0 729 0 0 730 0 0 731 0 0 732 0 0 733 0 0 734 0 0 735 0 0 736 0 0 737 0 0 738 0 0 739 0 0 740 0 0 741 0 0 742 0 0 743 0 0 744 0 0 745 0 0 746 0 0 747 0 0 748 0 0 749 0 0 750 0 0 751 0 0 752 0 0 753 0 0 754 0 0 755 0 0 756 0 0 757 0 0 758 0 0 759 0 0 760 0 0 761 0 0 762 0 0
![Page 188: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/188.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 188 OF 221 PAGES
763 0 0 764 0 0 765 0 0 766 0 0 767 0 0 768 0 0 769 0 0 770 0 0 771 0 0 772 0 0 773 0 0 774 0 0 775 0 0 776 0 0 777 0 0 778 0 0 779 0 0 780 0 0 781 0 0 782 0 0 783 0 0 784 0 0 785 0 0 786 0 0 787 0 0 788 0 0 789 0 0 790 0 0 791 0 0 792 0 0 793 0 0 794 0 0 795 0 0 796 0 0 797 0 0 798 0 0 799 0 0 800 0 0 801 0 0
![Page 189: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/189.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 189 OF 221 PAGES
802 0 0 803 0 0 804 0 0 805 0 0 806 0 0 807 0 0 808 0 0 809 0 0 810 0 0 811 0 0 812 0 0 813 0 0 814 0 0 815 0 0 816 0 0 817 0 0 818 0 0 819 0 0 820 0 0 821 0 0 822 0 0 823 0 0 824 0 0 825 0 0 826 0 0 827 0 0 828 0 0 829 0 0 830 0 0 831 0 0 832 0 0 833 0 0 834 0 0 835 0 0 836 0 0 837 0 0 838 0 0 839 0 0 840 0 0
![Page 190: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/190.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 190 OF 221 PAGES
841 0 0 842 0 0 843 0 0 844 0 0 845 0 0 846 0 0 847 0 0 848 0 0 849 0 0 850 0 0 851 0 0 852 0 0 853 0 0 854 0 0 855 0 0 856 0 0 857 0 0 858 0 0 859 0 0 860 0 0 861 0 0 862 0 0 863 0 0 864 0 0 865 0 0 866 0 0 867 0 0 868 0 0 869 0 0 870 0 0 871 0 0 872 0 0 873 0 0 874 0 0 875 0 0 876 0 0 877 0 0 878 0 0 879 0 0
![Page 191: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/191.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 191 OF 221 PAGES
880 0 0 881 0 0 882 0 0 883 0 0 884 0 0 885 0 0 886 0 0 887 0 0 888 0 0 889 0 0 890 0 0 891 0 0 892 0 0 893 0 0 894 0 0 895 0 0 896 0 0 897 0 0 898 0 0 899 0 0 900 0 0 901 0 0 902 0 0 903 0 0 904 0 0 905 0 0 906 0 0 907 0 0 908 0 0 909 0 0 910 0 0 911 0 0 912 0 0 913 0 0 914 0 0 915 0 0 916 0 0 917 0 0 918 0 0
![Page 192: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/192.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 192 OF 221 PAGES
919 0 0 920 0 0 921 0 0 922 0 0 923 0 0 924 0 0 925 0 0 926 0 0 927 0 0 928 0 0 929 0 0 930 0 0 931 0 0 932 0 0 933 0 0 934 0 0 935 0 0 936 0 0 937 0 0 938 0 0 939 0 0 940 0 0 941 0 0 942 0 0 943 0 0 944 0 0 945 0 0 946 0 0 947 0 0 948 0 0 949 0 0 950 0 0 951 0 0 952 0 0 953 0 0 954 0 0 955 0 0 956 0 0 957 0 0
![Page 193: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/193.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 193 OF 221 PAGES
958 0 0 959 0 0 960 0 0 961 0 0 962 0 0 963 0 0 964 0 0 965 0 0 966 0 0 967 0 0 968 0 0 969 0 0 970 0 0 971 0 0 972 0 0 973 0 0 974 0 0 975 0 0 976 0 0 977 0 0 978 0 0 979 0 0 980 0 0 981 0 0 982 0 0 983 0 0 984 0 0 985 0 0 986 0 0 987 0 0 988 0 0 989 0 0 990 0 0 991 0 0 992 0 0 993 0 0 994 0 0 995 0 0 996 0 0
![Page 194: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/194.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 194 OF 221 PAGES
997 0 0 998 0 0 999 0 0 1000 0 0
ACKNOWLEDGEMENT RECEIPT (PAR/POR/TRANSACTION REFERENCE NO.)
GRAND TOTAL (PS+ES) 0.00 0.00
4 APPLICABLE PERIOD REMITTED AMOUNT ACKNOWLEDGEMENT RECEIPT TRANSACTION DATE
DECEMBER 0.00 0 (To be accomplished on every page) 0.00 1/14/2016 3:57
UNDER THE PENALTY OF THE LAW, I HEREBY ATTEST THAT THE ABOVE INFORMATIONS PROVIDED HEREIN ARE TRUE AND CORRECT.
Signature over printed name Official Designation Date
Indicate Total Number of employees per page
14 1512
16
13SIGNATURE OVER PRINTED NAME
OFFICIAL DESIGNATION
DATE
![Page 195: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/195.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 195 OF 221 PAGES
THIS PORTION TO BE FILLED UP BY PHILHEALTH
DECEMBER 2015
EMPLOYEE STATUS
APPLICABLE PERIOD
S-Separated, NE-No Earnings, NH-Newly Hired / Effectivity Date
11
Action Taken:
![Page 196: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/196.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 196 OF 221 PAGES
![Page 197: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/197.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 197 OF 221 PAGES
![Page 198: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/198.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 198 OF 221 PAGES
![Page 199: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/199.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 199 OF 221 PAGES
![Page 200: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/200.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 200 OF 221 PAGES
![Page 201: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/201.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 201 OF 221 PAGES
![Page 202: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/202.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 202 OF 221 PAGES
![Page 203: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/203.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 203 OF 221 PAGES
![Page 204: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/204.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 204 OF 221 PAGES
![Page 205: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/205.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 205 OF 221 PAGES
![Page 206: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/206.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 206 OF 221 PAGES
![Page 207: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/207.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 207 OF 221 PAGES
![Page 208: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/208.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 208 OF 221 PAGES
![Page 209: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/209.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 209 OF 221 PAGES
![Page 210: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/210.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 210 OF 221 PAGES
![Page 211: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/211.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 211 OF 221 PAGES
![Page 212: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/212.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 212 OF 221 PAGES
![Page 213: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/213.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 213 OF 221 PAGES
![Page 214: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/214.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 214 OF 221 PAGES
![Page 215: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/215.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 215 OF 221 PAGES
![Page 216: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/216.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 216 OF 221 PAGES
![Page 217: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/217.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 217 OF 221 PAGES
![Page 218: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/218.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 218 OF 221 PAGES
![Page 219: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/219.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 219 OF 221 PAGES
![Page 220: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/220.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 220 OF 221 PAGES
![Page 221: Philhealth Form](https://reader035.vdocument.in/reader035/viewer/2022082202/56d6c0a01a28ab30169b25fc/html5/thumbnails/221.jpg)
This form maybe reproduced and is NOT FOR SALE
marc punzalan PLEASE READ INSTRUCTIONS (FOR EACH NUMBERED BOX) AT THE BACK BEFORE ACCOMPLISHING THIS FORM | 17 | PAGE 221 OF 221 PAGES
1/14/2016 3:57
UNDER THE PENALTY OF THE LAW, I HEREBY ATTEST THAT THE ABOVE INFORMATIONS PROVIDED HEREIN ARE TRUE AND CORRECT.
SIGNATURE OVER PRINTED NAME
OFFICIAL DESIGNATION
DATE