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PPS-HEUR2 Household Employment Unified Report Form
PhilHealth report form for household employment
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: PPS-HEUR2 FORM (V.1)
Republic of the Philippines
HOUSEHOLD EMPLOYMENT UNIFIED REPORT FORM
(Pursuant to R.A. 10361 or the "Batas Kasambahay")
PLEASE READ THE INSTRUCTIONS AT THE BACK BEFORE FILLING OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK OR BLUE INK ONLY.
PART I - EMPLOYER INFORMATION
Pag-IBIG Household Employer ID Number
PHILHEALTH Employer Number (PEN)
SSS Household Employer ID Number
TYPE OF
REPORT
INITIAL LIST (ATTACH WITH HOUSEHOLD EMPLOYER UNIFIED REGISTRATION FORM (PPS-HEUR1))
SUBSEQUENT LIST
EMPLOYER NAME
LAST NAME
FIRST NAME
NAME EXTENSION
(Pangalan)
(Ex. Jr. / II)
CHECK IF NO MIDDLE NAME
(I-tsek ang kahon kung walang
gitnang pangalan)
MIDDLE NAME
(Apelyido)
(Gitnang Pangalan)
PART II - KASAMBAHAY INFORMATION
Pag-IBIG MID NO./RTN
PHILHEALTH IDENTIFICATION NO. (PIN) SOCIAL SECURITY (SS) NO.
1. KASAMBAHAY NAME
(Pangalan ng Kasambahay)
LAST NAME
FIRST NAME
NAME EXTENSION
MIDDLE NAME
(Apelyido)
(Pangalan)
(Ex. Jr. / II)
(Gitnang Pangalan)
DATE OF BIRTH
DATE OF EMPLOYMENT
DATE OF SEPARATION
MONTHLY WAGE/SALARY/ EARNINGS
RELATIONSHIP TO HOUSEHOLD EMPLOYER
(MM-DD-YYYY)
(MM-DD-YYYY)
(MM-DD-YYYY)
(Buwanang Sweldo)
CHECK IF NO
MIDDLE NAME
(Relasyon sa Household Employer)
-
-
-
Pag-IBIG MID NO./RTN
-
-
-
PHILHEALTH IDENTIFICATION NO. (PIN) SOCIAL SECURITY (SS) NO.
2. KASAMBAHAY NAME
(Pangalan ng Kasambahay)
LAST NAME
FIRST NAME
NAME EXTENSION
MIDDLE NAME
(Apelyido)
(Pangalan)
(Ex. Jr. / II)
(Gitnang Pangalan)
DATE OF BIRTH
DATE OF EMPLOYMENT
DATE OF SEPARATION
MONTHLY WAGE/SALARY/ EARNINGS
RELATIONSHIP TO HOUSEHOLD EMPLOYER
(MM-DD-YYYY)
(MM-DD-YYYY)
(MM-DD-YYYY)
(Buwanang Sweldo)
CHECK IF NO
MIDDLE NAME
(Relasyon sa Household Employer)
-
-
-
Pag-IBIG MID NO./RTN
-
-
-
PHILHEALTH IDENTIFICATION NO. (PIN) SOCIAL SECURITY (SS) NO.
3. KASAMBAHAY NAME
(Pangalan ng Kasambahay)
LAST NAME
FIRST NAME
NAME EXTENSION
MIDDLE NAME
(Apelyido)
(Pangalan)
(Ex. Jr. / II)
(Gitnang Pangalan)
DATE OF BIRTH
DATE OF EMPLOYMENT
DATE OF SEPARATION
MONTHLY WAGE/SALARY/ EARNINGS
RELATIONSHIP TO HOUSEHOLD EMPLOYER
(MM-DD-YYYY)
(MM-DD-YYYY)
(MM-DD-YYYY)
(Buwanang Sweldo)
CHECK IF NO
MIDDLE NAME
(Relasyon sa Household Employer)
-
-
-
-
-
I certify that the information provided in this form are true and correct.
TOTAL NUMBER OF
KASAMBAHAY/S
FOR THIS REPORT
SIGNATURE OF HOUSEHOLD EMPLOYER
PAGE _____ OF _____ PAGE/S
(Use extra sheet if necessary)
DATE
PART III - TO BE FILLED OUT BY Pag-IBIG/PHILHEALTH/SSS
RECEIVED BY
Pag-IBIG
PHILHEALTH
SIGNATURE OVER PRINTED NAME
SSS
DATE & TIME
BRANCH
PART IV - CERTIFICATION (If filed through an Authorized Representative)
This is to certify that a Letter of Authorization from the Household Employer was presented and that the signature was verified based on the valid ID presented.
PRINTED NAME OF AUTHORIZED OFFICER
OF RECEIVING AGENCY
SIGNATURE
THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE
DATE & TIME
INSTRUCTIONS
1. This form is not applicable for reporting of Family Driver.
2. A household employer who is not yet registered with any of the agencies must submit this form in triplicate (3) copies together with the Household Employer Unified Registration
Form (HEUR1), in 3 copies also, to any service office of Pag-IBIG, PhilHealth or SSS.
3. An employer already registered with Pag-IBIG, SSS and PhilHealth will submit this form in triplicate (3) copies to any office of the said agencies to report (a) newly hired employee/s
or (b) to report a separated/terminated employee/s.
4. ALL FIELDS SHALL BE FILLED-OUT CORRECTLY BY THE HOUSEHOLD EMPLOYER, except Part III & IV.
5. If duly accomplished Form is filed/submitted through an Authorized Representative of the Household Employer, presentation of the following is required:
- Letter of Authorization from Household Employer
- Valid ID of the Household Employer
- Valid ID of the Authorized Representative
6. For SSS purposes only:
(a) Household Employer should submit to SSS the Specimen Signature Card (SSS Form L-501) which is available at all SSS Branches and Service Offices or may be downloaded from the
SSS website (www.sss.gov.ph). The SSS Form L-501 contains the Authorized Signatories of the Household Employer.
(b) In case the Date of Employment of the Kasambahay is earlier than the date of submission of this Form, the basis of the Effective Date of Coverage is the Date of Employment and the
start of the Household Employer's obligation to remit the contributions of the Kasambahay . The Household Employer should proceed to any SSS Branch or Service Office.
7. For Pag-IBIG purposes only:
(a) Household Employer should submit Specimen Signature Form (SSF, HQP-PFF-003) which is available at all Pag-IBIG NCR/Regional Branches or may be downloaded from Pag-IBIG Fund
website at www.pagibigfund.gov.ph.
