Get Sickness Form

Filling out the Sickness Benefit Application Form is an essential step for individuals seeking to claim their sickness benefits. This guide provides a clear, step-by-step process to help users navigate the form online, ensuring all necessary information is accurately provided.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the Sickness Form and open it in your preferred editor.
2. Enter your claim number, along with your Social Security System (SS) number. This information helps in identifying your application.
3. Complete the claimant section by providing your full name, including first name, middle initial, and last name.
4. Input your date of birth, ensuring that the format aligns with any guidelines provided in the form.
5. Fill in your full address, providing as much detail as necessary for accurate identification.
6. Record the date when you notified the Social Security System (SSS) about your claim.
7. Specify the confinement period by filling in the start date, end date, and the name of the hospital or the home where you were confined.
8. Indicate the number of days you were confined during the illness period.
9. Answer whether you were employed during the period of sickness for which you are claiming benefits. Select 'Yes' or 'No' accordingly.
10. If applicable, provide details of your last employer, including their name, address, period of employment, employer ID number, exact date of separation, and total monthly salary credits.
11. Include the certification of separation if necessary. This may involve the signature and printed name of a company representative along with their official designation.
12. Affirm the accuracy of the information provided by signing the form as the claimant.
13. If you have previous employers, document their names, addresses, and inclusive periods of employment.
14. Review the form to ensure all information is complete and correct before submission.
15. Once validated, save changes to the document. You may also download, print, or share the completed form.

Start completing your Sickness Form online today to ensure you receive the benefits you deserve.