Get your PMRF Form in 3 easy steps
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01 Fill and edit template
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02 Sign it online
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03 Export or print immediately
What is a PMRF Form?
The PMRF Form of PhilHealth is a two-page application that Filipino citizens can use to become a member of the local insurance program. You need to obtain a PhilHealth Identification Number before filling it out. You do not need other documents.
What do I need the PMRF Form in PhilHealth for?
- Use the PhilHealth PMRF Form to apply for membership in the PhilHealth program.
- This same form should be used if there has been any change in your personal data and you need to update or amend information that you previously provided.
- Non-citizens of the country can also partake in the insurance program, but they need to complete the PMRF-FN.
How to fill up PhilHealth Form PMRF?
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Enter your PIN and preferable healthcare provider and select the purpose of filling out the document: registration or making changes to personal information.
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Write your full name, as well as the maiden name of your mother and spouse (if you are married).
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Enter date and place of birth, gender, citizenship, civil status, TIN, and PhilSys ID Number.
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Provide information about your registration and mailing addresses and enter all your contact details.
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If you have dependents, fill in their information in the appropriate block of the PMRF Form PDF. If not, indicate “not applicable.”
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Select the type of membership and indicate your occupation and income.
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If you need to correct the previous form, select the type of correction in the last paragraph.
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Date and sign (or thumbprint) the PhilHealth PMRF Form, download it, and print it or email it to the recipient.
Organizations that work with the PMRF PhilHealth Form
- PhilHealth
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Fillable online PMRF Form