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Republic of the Philippines

RF-1
PHILIPPINE HEALTH INSURANCE CORPORATION EMPLOYER’S REMITTANCE REPORT
Healthline 441-7444 www.philhealth.gov.ph FOR PHILHEALTH USE
actioncenter@philhealth.gov.ph
Revised February 2014

1 Date Received: __________________ Action Taken:

PHILHEALTH NO. 0 0 1 0 0 0 0 6 2 3 5 5
By: ____________________________
EMPLOYER TIN 0 0 8 8 9 7 6 6 7 Signature Over Printed Name
2 BESPOKE BLISS PROPERTY DEVELOPMENT INC.
COMPLETE EMPLOYER NAME ___________________________________________________________________ 3 EMPLOYER TYPE 4 REPORT TYPE 5 APPLICABLE PERIOD
30TH FLOOR TYCOON CENTRE, PEARL DRIVE, BRGY SAN ANTONIO
COMPLETE MAILING ADDRESS __________________________________________________________________ PRIVATE REGULAR RF-1 NOVEMBR 2019
_________________
PASIG CITY, METRO MANILA 1605
__________________________________________________________________ GOVERNMENT ADDITION TO PREVIOUS RF-1
02-8732-5055
TELEPHONE NO. ______________________________ reception1bbpdi@gmail.com
EMAIL ADRESS _________________________________ HOUSEHOLD DEDUCTION TO PREVIOUS RF-1
6 7 8 Fill out this portion only if 10 NHIP PREMIUM 11
EMPLOYEES INFORMATION declared employee/s has not 9 CONTRIBUTION EMPLOYEE STATUS
PHILHEALTH IDENTIFICATION NUMBER yet been issued his/her PIN
(PIN) NAME EXT. DATE OF BIRTH SEX MONTHLY S-Separated, NE-No Earnings,
LAST NAME FIRST NAME (SR./JR.) MIDDLE NAME (mm-dd-yyyy)
SALARY PS ES NH-Newly Hired /
(M/F) BRACKET Effectivity Date

0 1 0 5 2 0 6 7 5 2 9 4 RAMOTA ARIANNE CATUIRAN F

1.
05 04 1994 18,000.00 247.50 247.50

0 2 5 0 4 8 9 0 8 6 MARASIGAN RAFAEL LEVEN SULIT 12 17 1968 M 15,000.00 206.25 206.25

2.
0 1
3.

4.

5.

6.

7.

8.

9.

10 .

12 13 14 15 PREPARED BY:
ACKNOWLEDGEMENT RECEIPT (PAR/POR/TRANSACTION REFERENCE NO.) SUBTOTAL (PS + ES) 267.75 267.75
2 Arianne C. Ramota
______________________
__________ (To be accomplished on every page)
SIGNATURE OVER PRINTED NAME
ACKNOWLEDGEMENT
Indicate Total Number of
APPLICABLE PERIOD REMITTED AMOUNT
RECEIPT
TRANSACTION DATE NO. OF EMPLOYEES 907.50 Executive Assistant
______________________
OFFICIAL DESIGNATION
employees per page GRAND TOTAL (PS + ES) Dec 04 2019
(To be accomplished on every page) __________________
NOVEMBER 2019 907.50 323144974 03 DEC 2019 2 DATE

16
UNDER THE PENALTY OF THE LAW, I HEREBY ATTEST THAT THE ABOVE INFORMATION PROVIDED HEREIN ARE TRUE AND CORRECT.
MA. MYRNA CEILO C. TIONGSON
____________________________________________ PRESIDENT
________________________________________ Dec 04 2019
_________________________
Signature over printed name Official Designation Date

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