SSS Request/Verification Form

Other SSS Forms

Unified Multi-Purpose ID (UMID) Card Application Form

SSS # Application Form

Kasambahay Unified Registration Form

SOCIAL SECURITY SYSTEM – Request/Verification Form

INSTRUCTIONS

1. Instructions fill out this form in (1) one copy and accomplish appropriate parts as follows:

Filed by member

• Number to fill out part I (a to c)
• Member to fill out employment history (Part I [b]) only if requesting for the following:

• Cancellation of Multiple SS Number
• Consolidation of Contributions
• Correction/Refund/Posting/Adjustment of Contributions
• Deletion of Entry in Employment History Record
• Encoding/Correction of Date of Coverage
• Manual Verification

Filed by authorized representative for company representative

• Member to fill out Part I (a to d)
• Authorized Representative or company representative to fill out Part I (d)

2. Place a checkmark on the application
3. Always indicate “N/A” or “Not Applicable”, if the required data is not applicable.
4. Present identification document/s.

Filed by member

• Social security (SS) Card or Unified Multi-Purpose ID (UMID) Card or Passport or Professional Regulation Commission (PRC) Card or Seaman’s Book or Driver’s License or two (2) valid IDs (both with signature and at least one (1) with photo)

Filed by authorized representative

• Representative’s SS Card or UMID Card or Passport or PRC Card or Seaman’s Book or Driver’s license or any two (2) valid IDs (both with signature and at least one (1) with photo)
• Members SS Card or UMID Card or Passport or PRC Card or Seaman’s Book or Driver’s License or any two (2) valid IDs (both with signature and at least one with photo)

Filed by company representative

• Authorized Representative Card (ACR)
• Original member’s SS Card or UMID Card or Passport Card or PRC Card or Seaman’s Book or Driver’s License or any two (2) valid IDs (both with signature and at least one (1) with photo)

5. The member granting authority to the authorized representative or company representative in this form shall be held liable under all circumstances for any false statement, misrepresentation, fraud made by the authorized representative or company representative in all transactions with the SSS.
6. This form can be downloaded through the SSS Website at http://www.sss.gov.ph.