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Get Philhealth Er1 Form

ATA RECORD 1. Name of Agency/Office/Department (for Gov t. Sector)/Business/Firm/Employer (for private Sector) TIN 2. Address of Agency/Office/ Department/Business/Firm/Employer 2a. Tel. No. 3. E-Mail Address 3a. Postal Code 4. If Regional/Branch Office, State the name and address of Main/Head Office 4a. Main/Head Office/Employer 4b. Date Operation Started 4c. No. of Employees 5. Services Rendered/Nature of Business/Operation (for Private Sector) 6. Type of Agency (For Gov t Sector.

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