LHIO Camarines Sur
Westpark Leisure Hub, Magsaysay Avenue, Balatas, Naga City 4400
PhilHealth Online Access Form (POAF)
Please encode your twelve (12) digits PEN
PEN
*
EMPLOYER NAME
*
ADDRESS
*
CONTACT NUMBER
*
NAME OF AUTHORIZED SIGNATORY
*
DESIGNATION OF AUTHORIZED SIGNATORY
*
EMAIL ADDRESS OF THE COMPANY
example@example.com
PhilHealth Employer Engagement Representative (PEER)
Below is the information of your nominated Electronic Premium Reporting System (EPRS) User. By nominating the said person, you are granting her/him complete access of your records to PhilHealth.
Name
*
First Name
Middle Name
Last Name
Designation/Position
*
Email
*
example@example.com
Cellphone Number
*
-
Area Code
Phone Number
Terms and Conditions
*
Please verify that you are human
*
Submit
Should be Empty: