Guidance for Completing the Declaration Form for Participating, Adjusting Social Insurance, Health Insurance Information (Form TK1-TS)

In case the Social Insurance code has not yet been issued:

The participant fills out from indicator [01] to indicator [13]. In case the participant joins the household-based health insurance for a contribution reduction, supplementary indicator [14] is filled out. Annex of household members.

The declaration indicators are guided as follows:

[01]. Full name: Write the complete surname, middle name, and first name in uppercase letters with accents of the participant;

[02]. Date of birth: Fully record the date of birth as in the birth certificate or personal ID card, passport, identification card;

[03]. Gender: If male, write “male” or if female, write “female”;

[04]. Nationality: Write as stated in the birth certificate or personal ID card, passport, identification card.

[05]. Ethnicity: Write as stated in the birth certificate or personal ID card, passport, identification card.

[06]. Place of Birth Registration: Clearly state the name of the commune (ward, commune-level town), district (district-level town, city under the province), province, city where the birth certificate was registered.

In case the place of first birth certificate issuance cannot be determined, write the place of origin (if there has been a merger or division of administrative boundaries, write according to the place name at the time of declaration) or write according to the place of permanent residence or temporary residence registration.

[07]. Address for receiving results: Fully record the address where currently living so that the Social Insurance agency can send the Social Insurance book, Health Insurance card, or results of other administrative procedures: house number, street; hamlet; commune (ward, commune-level town); district (district-level town, city under the province); province, city.

[08]. Personal ID number/Passport/Identification card: Record the personal ID number or passport number or identification card number.

[09]. Contact phone number: Record the contact phone number (if any).

[10]. Father's or mother's name, or guardian (applicable for children under 6 years old): Write the name of the father or mother or guardian.

[11]. Contribution amount (applicable for voluntary Social Insurance participants): Record the monthly income chosen by the voluntary Social Insurance participant.

[12]. Contribution method (applicable for laborers working abroad, voluntary Social Insurance participants): Specifically record the contribution method as 03 months or 06 months or 12 months...

[13]. Initial medical examination registration place: Record the place of initial health insurance medical examination and treatment registration (the list of initial medical examination registration places is annually notified by the Social Insurance agency to units, commune People's Committees, collection agents).

[14]. Annex of household members: Fully and accurately declare the information of all household members in the household registration book or temporary residence book of participants in household-based health insurance who enjoy a contribution reduction.

In case the Social Insurance code has been issued, changing information recorded in the Social Insurance book, Health Insurance card:

The declaration indicators are guided as follows:

[01]. Full name: Write the complete surname, middle name, and first name in uppercase letters with accents of the participant in Social Insurance, Health Insurance, Unemployment Insurance, Work Injury–Occupational Disease Insurance;

[02]. Date of birth: Fully record the date of birth as in the birth certificate or personal ID card, passport, identification card.

[03]. Social Insurance code: Record the participant’s Social Insurance code.

[04]. Content change request: Record the content request for change such as: full name, date of birth, information related to position, occupation, job, contribution method, initial medical examination registration place...

[05]. Attached documents:

- For information adjustments, record the types of proof documents.- For participants entitled to higher Health Insurance benefits, record the types of proof documents.

After completing the declaration, the participant signs, clearly stating their full name. In case of declaring changes in personal information (surname, middle name, first name; date of birth, gender) recorded in the Social Insurance book, Health Insurance card, it must be confirmed by the unit where the worker is employed. For those who are reserving the Social Insurance payment period, confirmation is not required.

Details of the Declaration Form (Form TK1-TS) are attached to Decision 888/QD-BHXH effective from July 01, 2018.

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