TRANSMITTAL SHEET

DESCRIPTION OF ITEM/S (Please check):

SSS Sickness Notification Form
SSS Sickness Benefit Reimbursement Form
Application for Sickness Benefits Form
Photocopy of SSS Digitized ID, E6 or two (2) government IDs with three (3) original signatures
Print out of static report & contributions from SSS Website
Certified True Copy of medical records, other clinical record/diagnostic procedure results
Others: ____________________________________________

EMPLOYEE NAME : _________________________ E-MAIL ADDRESS: ______________________

SITE : _________________________ CONTACT NUMBER: ______________________

CUT ALONG THIS LINE, ATTACH THIS TRANSMITTAL SHEET TO YOUR FORMS AND SUBMIT YOUR DOCUMENTS TO SITE CBT

GUIDELINES IN APPLYING FOR SSS SICKNESS BENEFITS

In applying for SSS Sickness Benefit, please complete the following:

I. Accomplish one (1) copy of CLD-9N SSS Sickness Notification

• Use BLACK INK only. Avoid erasures or countersign any alterations made on the form.
• Complete all required fields in the Part I portion of the form. Use the same signature as reflected in your SSS ID
card or valid ID’s submitted.
• Ask your attending physician to sign Part III of the form. Ensure to have his/her signature & registration number
indicated in the form.
• For Home Confinement/Out-patient, duly filled out SSS Sickness Notification form and supporting documents
must be submitted to HR Central Benefits office within five (5) calendar days from the start of confinement. This is
a strict rule of SSS and late notification will result to either reduced number of approved days or disapproved claim.
If unable to submit the hard copies, the employee may send the scanned copies of their notification forms to
hrcentralbenefits@sykes.com within five (5) calendar days, but hard copies must be submitted to HR within the
30 calendar days from start of sickness.

Note: Employees sent home for quarantine under the COVID Suspect category must send the scanned copy of their notification
forms first bearing the following details (hrcentralbenefits@sykes.com)
• Quarantine Pass (from clinic)
• SSS number
• Number of days for recuperation
• License number of physicians
Hard copies may be submitted once they have finished their quarantine period.

• Please indicate your SSS number at the upper right corner in all pages of your documents

II. Accomplish one (1) copy of B-301 SSS Sickness Benefit Reimbursement Form
• Use BLACK INK only. Avoid erasures or countersign any alterations made on the form.
• Complete item # 4, 5, 6 and employee’s signature. Use the same signature as reflected in your SSS ID card or valid
ID’s submitted.

III. Read and sign one (1) copy of Application for Sickness Benefits Form
• Please indicate your employee number.
• Indicate your cell phone number or email address in the corresponding fields. Updates to your maternity
applications will be forwarded to these contact details, including expected date of credit to your payroll account.

IV. Attach necessary supporting documents.

• Certified True Copy of medical records (Hospital abstract, Operating Room Record, X-ray, CT Scan, ECG,
Ultrasound results, if any), Other clinical record/diagnostic procedure results
• Print out of static report/member details & contributions from the SSS Website
• Photocopy of proof of Identification (SSS ID or two (2) other valid IDs, both with signature and at least one (1) with
photo and date of birth) with three (3) original signatures
V. Send these documents to HR Compensation & Benefits Team.
• Accomplish the Transmittal Sheet above and attach documents enumerated in items I, II, III and IV.
• Submit your documents directly to the Central Benefits office in your respective site.

VI. Questions?
• For status & computation of your Sickness Benefits, please post ticket in PH HR Helpdesk under HR Compensation
& Benefits
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 APPLICATION FOR SICKNESS BENEFITS
WITH AUTHORITY TO DEDUCT

I hereby submit the documents below to support my application for SSS Sickness Benefits:
• SSS Sickness Notification Form with attending Physician’s certification
• Photocopy of SSS Digitized ID or E6 stub or two (2) valid government ID’s with three (3) original signatures
• Print out of static report & contributions from SSS Website
• Signed SSS Sickness Reimbursement Form

I acknowledge that, once my application is approved, the corresponding payment shall be advanced by the company and
deposited into my payroll account, such deposit I authorize the company to make.

I understand and accept that, I am required to submit all relevant documents as may be required by HR and/or by the SSS before
any payment can be made for my Sickness Benefit. I know that I am obliged to submit the proper documents in a timely manner
and do all things necessary to complete the reimbursement from SSS of the above advances.

Should I fail to submit the required documents within the specified time or do all things necessary to allow
reimbursement by SSS, or if SSS pays less than the amount of the sickness benefit advanced by the company, I hereby
authorize the company to automatically deduct the corresponding amount representing the SSS maternity benefits advanced by
the company from my salary, allowances, incentives, and all other amounts due and owing to me by the company, including my
final pay (if separated from employment). Such authority shall be valid and binding until the obligation is paid in full or s aid
advances have been fully reimbursed with SSS.

If an active employee, I may also be sanctioned by the company for disobedience and neglect of duty or other appropriate
penalties under the company’s Code of Conduct if warranted by the circumstances.

By signing my name below, I hereby acknowledge that I have read this document in its entirety, understood its contents and
agree to the matters set forth herein.

✓
__________________________
(Signature over Printed Name)

✓ Date Signed : ______________________

✓ Employee Number : ______________________
✓ Employee Name : ______________________
✓ Contact No : ______________________
✓ Name of Hospital : ______________________
✓ E-mail Address : ______________________
✓ Department/Program : ______________________
✓ Immediate Supervisor : ______________________