Mat-2 - Maternity Reimbursement (Republic Of The Philippines Social Security System)

ADVERTISEMENT

Republic of the Philippines
MAT-2
MATERNITY REIMBURSEMENT
REV. 03-99
(Please read instructions at the back. Print all information in black ink.)
SS NUMBER
TYPE OF MEMBERSHIP (CHECK APPLICABLE BOX)
EMPLOYED
VOLUNTARY
SELF-EMPLOYED
SEPARATED
Date of Separation
NAME (SURNAME)
(GIVEN NAME)
(MIDDLE NAME)
HOME ADDRESS (NUMBER & STREET)
(BARANGAY)
(TOWN/DISTRICT)
(CITY/PROVINCE)
POSTAL CODE
START OF MATERNITY LEAVE
DATE OF DELIVERY/MISCARRIAGE
M M D D
Y Y Y Y
M M D D
Y Y Y Y
TYPE OF DELIVERY (CHECK APPLICABLE BOX)
NUMBER OF PREGNANCY/IES
NORMAL
COMPLETE DELIVERY/IES
CESAREAN
MISCARRIAGE/ABORTION
MISCARRIAGE
TOTAL MONTHLY SALARY CREDIT
I CERTIFY THAT THE ABOVE-STATED INFORMATION ARE CORRECT.
SIGNATURE
FOR EMPLOYER USE
EMPLOYER’S ID NUMBER
EMPLOYER’S NAME
HOME ADDRESS (NUMBER & STREET)
(BARANGAY)
(TOWN/DISTRICT)
(CITY/PROVINCE)
POSTAL CODE
THIS IS TO CERTIFY THAT THE MATERNITY BENEFIT OF THE ABOVE-NAMED MEMBER HAS BEEN PAID IN THE AMOUNT OF _________________________
__________________________P ( __________________ ) ON _________________________ AND THAT THE ABOVE INFORMATION ARE CORRECT.
NAME OF EMPLOYER’S AUTHORIZED REPRESENTATIVE
SIGNATURE
DATE
FOR SSS USE
PROCESSED / DATE:
RECEIVED / DATE:
SIGNATURE OVER PRINTED NAME
Cut Here
MAT-2
ACKNOWLEDGEMENT STUB
REV. 03-99
MATERNITY REIMBURSEMENT
EMPLOYER’S ID NUMBER
EMPLOYER’S NAME
RECEIVED / DATE:
SS NUMBER
NAME (SURNAME)
(GIVEN NAME)
(MIDDLE NAME)
DATE OF DELIVERY/MISCARRIAGE
OTHER DOCUMENTS SUBMITTED (CHECK APPLICABLE BOX)
MAT-1
COPY OF REGISTERED
OTHERS
BIRTH CERTIFICATE
Internet Edition (7/2000)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2