PhilHealth Authorization Letter Format and Sample

Philhealth Authorization Letter is a document for authorizing an individual on your behalf to transact with the Philippine Health Insurance Corporation. The Authorization Letter includes the Philhealth Member’s name, signature, Philhealth ID number, name of representative, and purpose.

It should also state the name of the authorized representative, his/her relationship to the member, and the purpose of the visit to the PhilHealth office.

Philhealth members who cannot visit the PhilHealth office personally can send a representative to make transactions with the stated government office on their behalf. The representative has to carry the PhilHealth member’s authorization letter and show it to the staff of the government office.

Below is a sample format of the authorization letter that you can use as a reference when you need to make one for your authorized representative:

Sample PhilHealth Authorization Letter and Format

Name of PhilHealth Member
Address
Contact Details such as phone number or email

Current Date

PhilHealth Branch Office Name
Address of the branch

To Whom It May Concern;

I, (state your name here), a PhilHealth member with ID number (state the ID number here), hereby authorizes (state the name of your representative here), (state your relationship to your representative), currently residing in (state here the residence address of your representative) to request the following documents from your good office on my behalf:

  • List here the documents you are requesting
  • Document 2
  • Document 3

I will not be able to claim the said documents personally as I am (state here your reason why you cannot visit the PhilHealth office). Along with this letter, is a scanned copy of both my (state your valid identification card here) and (state the valid ID of your representative here) of my authorized representative.

Hoping for your kind consideration.

Respectfully Yours,

(PhilHealth member’s printed name and signature here)
_________________________________________

With my Authorized Representative:

(Authorized representative’s printed name and signature here)
_______________________________________

(Input here the contact detail of the authorized representative)
___________________________________

philhealth authorization letter format sample

Sample Filled Out PhilHealth Authorization Letter

Jose dela Isla
Abu Dhabi, United Arab Emirates
josedisla@email.com / +971 123456789

March 2, 2025

PhilHealth Regional Office Dagupan
Akia Building, Old De Venecia Highway
Dagupan City, Pangasinan

To Whom It May Concern;

I, Jose dela Isla, a PhilHealth member with ID number 02 – 250011863 – 5, hereby authorize Maria Clara dela Isla, my sister, currently residing in 123 Matiyaga Street, Dagupan Pangasinan to request the following documents from your office on my behalf:

  • Summary of Contribution
  • Updated MDR
  • ID / PIC

I will not be able to claim the said documents personally as I am working as an OFW here in Abu Dhabi, UAE. Along with this letter, is a scanned copy of both my Passport and the company ID of my authorized representative.

Hoping for your kind consideration.

Respectfully Yours,

Jose dela Isla signature over printed name here
_________________________________________

With my Authorized Representative:

Maria Clara dela Isla signature above printed name here
_________________________________________

Telephone/Mobile Phone Number: 8 – 76543- 21
_________________________________________

There you have it guys, I hope this helps.

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