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Get Ph Rf-1 2008

ALTH USE Date Received: PHILHEALTH NO. Action Taken: By: EMPLOYER TIN 2 Signature Over Printed Name 3 COMPLETE EMPLOYER NAME EMPLOYER TYPE COMPLETE MAILING ADDRESS 4 5 REPORT TYPE PRIVATE NAME OF EMPLOYEE/S NO. SURNAME ADDITION TO PREVIOUS RF-1 HOUSEHOLD 6 REGULAR RF-1 GOVERNMENT TELEPHONE NO. DEDUCTION TO PREVIOUS RF-1 7 GIVEN NAME 8 PHILHEALTH NO. MIDDLE NAME APPLICABLE PERIOD MONTHLY SALARY BRACKET (MSB) 9 NHIP PREMIUM CONTRIBUTION PS 200 10 MEMBER STATUS S-Sep.

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