Philippine Government Forms - sss

DDR-1 Rev. 03-99 Republic of the PhilippinesSOCIAL SECURITY SYSTEMDEATH, DISABILITY AND RETIREMENT CLAIM(Please read instructions at the back. Print all information in capital letters & use black ink only.)SS NUMBERNAME OF MEMBER(SURNAME)(GIVEN NAME)(MIDDLE NAME)ADDRESS(NUMBER & STREET)(BARANGAY)(TOWN/DISTRICT)(CITY/PR OVINCE)POSTAL CODEDATE OF BIRTH(MM/DD/YYYY)PLACE OF BIRTH(TOWN/DISTRICT)(CITY/PROVINCE)CIVIL STATUSSINGLEMARRIEDWIDOWTELEPHONE TYPED isabilityRetirementOpt to receive first 18 monthly pension in lump of a retiree or a total disability pensionerSSECDate of Death(MM/DD/YYYY)EMPLOYMENT HISTORYNAME OF EMPLOYERADDRESSPERIOD OF CHILDREN(BEGINNING FROM THE YOUNGEST)DATE OF BIRTH(MM/DD/YYYY)Check Applicable OF BANK/BRANCHBANK ADDRESSACCOUNT NUMBERBRSTNI CERTIFY:1. That the above-mentioned children are under my care and custody;2. That I am competent to receive in behalf of the said children the amount due them as dependents of the subject member of the SSS;3.

Form Guide: SSS Flexi-Fund for overseas Filipino workers. 1. OW-1 must be submitted to the nearest SSS foreign representative office or to the International Affairs and Branch Expansion Office through the mail, e-mail or fax for OFWs based in countries without existing SSS offices.

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