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Get PH CF1 2013-2024

Cted/collected and remitted to PhilHealth, and that the information supplied by the member or his/her representative on Part I are consistent with our available records. Date Signed: Signature Over Printed Name of Employer / Authorized Representative Official Capacity / Designation PART V - FOR PHILHEALTH USE ONLY Date Received: LHIO PRO By: LHIO/PRO Signature Over Printed Name month day year .

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