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Get PH SSS MAT-1 1999

The female member should submit this form together with the Pregnancy Test or Ultrasound Report at least 60 days from the date of conception to her employer if employed or to the SSS if separated/voluntary/self-employed member. 4. The employer must submit the maternity notification MAT-1 within 15 days upon receipt of notification from the employee. Republic of the Philippines MAT-1 SOCIAL SECURITY SYSTEM MATERNITY NOTIFICATION REV. 03-99 SS NUMBER Please read instructions at the back. 5. The maternity notification MAT-1 duly stamped received by the SSS should be attached to the properly filled out Maternity Reimbursement MAT-2. Print all information in black ink. TYPE OF MEMBERSHIP CHECK APPLICABLE BOX EMPLOYED NAME SURNAME VOLUNTARY SELF-EMPLOYED SEPARATED Date of Separation MIDDLE NAME GIVEN NAME HOME ADDRESS NUMBER STREET BARANGAY TOWN/DISTRICT CITY/PROVINCE POSTAL CODE THIS IS TO NOTIFY MY EMPLOYER/SSS THAT I AM EXPECTING TO GIVE BIRTH ON. BELOW IS MY PREGNANCY HISTORY. DELIVERY/IES MISCARRIAGE/S LAST DATE SIGNATURE DATE FOR EMPLOYER USE EMPLOYER NAME ADDRESS NUMBER STREET THIS IS TO CERTIFY THAT THE ABOVE-NAMED MEMBER IS PREGNANT AND IS EXPECTED TO GIVE BIRTH ON THE DATE STATED ABOVE* NAME OF EMPLOYER S AUTHORIZED REPRESENTATIVE FOR SSS USE PROCESSED/DATE RECEIVED/DATE SIGNATURE OVER PRINTED NAME CUT HERE Internet Edition 7/2000 THIS WILL BE KEPT BY SSS FOR REFERENCE PURPOSES INSTRUCTIONS 1. Accomplish and submit this form in one 1 copy. 2. Any alterations should be initialed by the member or the employer s authorized representative if employed* 3. The female member should submit this form together with the Pregnancy Test or Ultrasound Report at least 60 days from the date of conception to her employer if employed or to the SSS if separated/voluntary/self-employed member. Print all information in black ink. TYPE OF MEMBERSHIP CHECK APPLICABLE BOX EMPLOYED NAME SURNAME VOLUNTARY SELF-EMPLOYED SEPARATED Date of Separation MIDDLE NAME GIVEN NAME HOME ADDRESS NUMBER STREET BARANGAY TOWN/DISTRICT CITY/PROVINCE POSTAL CODE THIS IS TO NOTIFY MY EMPLOYER/SSS THAT I AM EXPECTING TO GIVE BIRTH ON. BELOW IS MY PREGNANCY HISTORY. DELIVERY/IES MISCARRIAGE/S LAST DATE SIGNATURE DATE FOR EMPLOYER USE EMPLOYER NAME ADDRESS NUMBER STREET THIS IS TO CERTIFY THAT THE ABOVE-NAMED MEMBER IS PREGNANT AND IS EXPECTED TO GIVE BIRTH ON THE DATE STATED ABOVE* NAME OF EMPLOYER S AUTHORIZED REPRESENTATIVE FOR SSS USE PROCESSED/DATE RECEIVED/DATE SIGNATURE OVER PRINTED NAME CUT HERE Internet Edition 7/2000 THIS WILL BE KEPT BY SSS FOR REFERENCE PURPOSES INSTRUCTIONS 1. BELOW IS MY PREGNANCY HISTORY. DELIVERY/IES MISCARRIAGE/S LAST DATE SIGNATURE DATE FOR EMPLOYER USE EMPLOYER NAME ADDRESS NUMBER STREET THIS IS TO CERTIFY THAT THE ABOVE-NAMED MEMBER IS PREGNANT AND IS EXPECTED TO GIVE BIRTH ON THE DATE STATED ABOVE* NAME OF EMPLOYER S AUTHORIZED REPRESENTATIVE FOR SSS USE PROCESSED/DATE RECEIVED/DATE SIGNATURE OVER PRINTED NAME CUT HERE Internet Edition 7/2000 THIS WILL BE KEPT BY SSS FOR REFERENCE PURPOSES INSTRUCTIONS 1. Accomplish and submit this form in one 1 copy. 2. Any alterations should be initialed by the member or the employer s authorized representative if employed* 3. .

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