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This document is a maternity notification form from the Social Security System of the Philippines. It contains fields for a member's personal information like name, address, SSN, and type of membership. It notifies the employer or SSS that the member is expecting to give birth on a certain date and includes their pregnancy history. The employer section is for the employer's signature and certification of the member's pregnancy. Instructions on the back explain that the form must be submitted at least 60 days before the expected delivery date along with medical documents and that the employer must submit it to SSS within 15 days of receiving it from the employee.

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Prucel Tada
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8K views3 pages

Mat 1 Form

This document is a maternity notification form from the Social Security System of the Philippines. It contains fields for a member's personal information like name, address, SSN, and type of membership. It notifies the employer or SSS that the member is expecting to give birth on a certain date and includes their pregnancy history. The employer section is for the employer's signature and certification of the member's pregnancy. Instructions on the back explain that the form must be submitted at least 60 days before the expected delivery date along with medical documents and that the employer must submit it to SSS within 15 days of receiving it from the employee.

Uploaded by

Prucel Tada
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

MAT- Republic of the Philippines

SOCIAL SECUPITY SYSTEM


1 MATERNITY NOTIFICATION
REV. 03-99 (Please read instructions at the back. Print all information in black ink.)

SS NUMBER
TYPE OF MEMBERSHIP (CHECK APPLICABLE BOX)
EMPLOYED VOLUNTARY SELF-EMPLOYED SEPARATED
Date of Separation
NAME
(GIVEN NAME) (MIDDLE NAME)
(SURNAME)

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
NUMBER LAST DATE

SIGNATURE DATE

FOR EMPLOYER USE


EMPLOYER ID NUMBER EMPLOYER NAME

ADDRESS (NUMBER & STREET) (BARANGAY)

(TOWN/ (CITY/ POSTAL CODE


DISTRICT) PROVINCE)

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 SIGNATURE DATE

FOR SSS USE


PROCESSED/DATE RECEIVED/DATE

SIGNATURE OVER PRINTED


NAME
CUT HERE

MAT-1 MATERNITY NOTIFICATION STUB


RECEIVED/DATE
REV. 03-99
THIS WILL BE KEPT BY SSS FOR REFERENCE
PURPOSES

SS NUMBER NAME (SURNAME) (GIVEN NAME) (MIDDLE NAME)


Internet Edition (7/2000)
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.

4. The employer must submit the maternity notification (MAT-1) within 15 days
upon receipt of notification from the employee.

5. The maternity notification (MAT-1) duly stamped received by the SSS should
be attached to the properly filled out Maternity Reimbursement
(MAT-2).

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