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This form may be reproduced and is NOT FOR SALEPHILHEALTH CLAIM FORM 1 Revised May 2000 Note: This form together with Claim Form 2 should be filed with Philomath within 60 calendar days from date

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4. Begin filling out the form by providing accurate personal information such as name, address, contact details, etc.
5. Follow the instructions on each section of the form and provide the required information accordingly.
6. Take your time to double-check the entered information for any errors or omissions.
7. If you have any doubts or confusion, refer to the provided guidelines or seek assistance from the concerned authority.
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9. Sign the form if required and submit it as instructed, either by mail or in person.
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