Republic of the Philippines SOCIAL SECURITY SYSTEM ALLOCATION OF MATERNITY LEAVE CREDITS SS1D-01408 (05.2019) THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE, THIS GAN ALSO BE DOWNLOADED THRU THE G56 WEBSITE AT wunwasngovph PLEASE READ THE INSTRUCTIONS AND REMINDERS AT THE BACK BEFORE FILLING OUT THIS FORM, PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY SS NUMBER NAME OF MEMBER CAST RANET FAST WAR TADS WANT SOE DO YOU WANT TO ALLOCATE PORTION OF YOUR MATERNITY LEAVE CREDITS? Dives. | want to allocate days which, shall be deducted from my SSE rralernity benefit, to: ‘aero ays 07 ays) Name Relatonship TD chies taner To Aiemate caregiver (No. t want to avail the full SSS matemity benefit PRINTED NAME OF MEMBER SGNATURE DATE Republic of the Philippines SOCIAL SECURITY SYSTEM ALLOCATION OF MATERNITY LEAVE CREDITS MT. "SID-01409 (05.20°9 "THIS FORM MAY RE REPRODUCED AND Ia NOT FOR SALE, THIS GAN ALSO BE DOWNLOADED THRU THE S56 WEBSITE AT wnnwasnpovieh PLEASE READ THE INSTRUCTIONS AND REMINOERS AT THE BACK BEFORE FILLING OUT THIS FORM, PRINT ALL INFORMATION IN CAPITAL LETTERS ANO USE BLACK INK ONLY. ‘SS NUNBE NAME OF MEMBER WASTWAVEY RSTO THOSE TET SORRY ‘DO VOU WANT TO ALLOCATE PORTION OF YOUR MATERNITY LEAVE OREDITS? Yes. twantio allocate days which, shall be deducted from my SSS maternity benef, to Tumba ofaape (167 do) Name: Relationship: O chite’s father © Atemate caregiver TF) No. | want to avail the full SSS maternity benefit PRINTED NAME OF MEMBER ‘SIGNATURE DATE Republic of the Philippines SOCIAL SECURITY SYSTEM ALLOCATION OF MATERNITY LEAVE CREDITS 'S10-01408 (05.2019) ‘THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE, THIS CAN ALSO BE DOWNLOADED THRU THE SSS WEBSITE AT wiew PLEASE READ THE INSTRUCTIONS AND REMINDERS AT THE BACK BEFORE FILLING OUT THIS FORM, PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY, ‘SS NUMGER [NAME OF MEMBER (AST WAEY HRS NAT TIDDTE WET SOFT ‘DO YOU WANT 10 ALLOCATE PORTION OF YOUR MATERNITY LEAVE CREDITS? N [21 Yes. I want to atlocate days which, shallbe deducted from my SSS maternlly benefit to: Tera Name: Relationship 1 chitas tater TD Atemate caregiver (Zo. want to aval he ful SSS maternity benefit PRINTED NAME OF MEMBER ‘SIGNATURE DATEINSTRUCTIONS Fill out this form in one (1) copy. Affix initials on all alterations/erasures in this form, Attach this form when submitting the Maternity Notification, REMINDERS. Allocation of maternity leave credits will be valid for live childbirth only. Child's father or alternate caregiver must be currently employed Alternate caregiver must be a relative within the fourth degree of consanguinity or your current partner sharing the same household. Maternity Notification with Allocation of Maternity Leave Credits duly received by the SSS or Maternity Notification ‘Submission Confirmation (if fled thru the SSS Website or thru Self-service Information Terminal) shall be attached to the Maternity Benefit Application/Maternity Benefit Reimbursement Application. INSTRUCTIONS Fill out this form in one (1) copy. Affix initials on all alterations/erasures in this form. Attach this form when submitting the Maternity Notification. REMINDERS Allocation of maternity leave credits will be valid for live chilabirth only. Chitd's fether or alternate caregiver must be currently employed. Alternate caregiver must be @ relative within the fourth deyree of consanguinity or your current partner sharing the same household Maternity Notification with Allocation of Maternity Leave Credits duly received by the SSS or Matemity Notification Submission Confirmation (if filed thru the SSS Website or thru Self-service Information Terminal) shall be attached to the Maternity Benefit Application/Maternity Benefit Reimbursement Application. INSTRUCTIONS Fill out this form in one (1) copy. Affix initials on all alterations/erasures in this form, Attach this form when submitting the Maternity Notification, REMINDERS Allocation of maternity leave credits wil be valid for live childbirth only, Child's father or alternate caregiver must be currently employed. Altemate caregiver must be a relative within the fourth degree of consanguinity or your current partner sharing the same household. Maternity Notification with Allocation of Maternity Leave Credits duly received by the SSS or Maternity Notification ‘Submission Confirmation (if fled thru the SSS Website or thru Self-service Information Terminal) shall be attached to the Maternity Benefit Application/Maternity Benefit Reimbursement Axplication.