SSS-Form-E-1

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○ ○ ○ SS NUMBER SOCIAL SECURITY SYSTEM ○ PERSONAL RECORD (Please Use Black Ink Only) (Gumamit ng Itim na Tinta Lamang) SURNAME (APELYIDO) (Rev. 08/94) MIDDLE NAME (GITNANG PANGALAN) E-1 ○ ○ ○ ○ ○ ○ ○ GIVEN NAME ○ ○ ADDRESS (NO. & STREET ; CITY/TOWN & PROVINCE) (TIRAHAN: BILANG AT KALYE, LUNGSOD/BAYAN AT LALAWIGAN) POSTAL CODE ○ ○ ○ ○ SEX MALE (LALAKI) DATE OF BIRTH FEMALE (BABAE) CIVIL STATUS (KATAYUANG SIBIL) ○ ○ (KAPANGANAKAN) m m d d y y ○ ○ SINGLE (WALAN
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  SS NUMBER SOCIAL SECURITY SYSTEMSOCIAL SECURITY SYSTEMSOCIAL SECURITY SYSTEMSOCIAL SECURITY SYSTEMSOCIAL SECURITY SYSTEM PERSONAL RECORD (Please Use Black Ink Only) (Gumamit ng Itim na Tinta Lamang)  E-1 (Rev. 08/94) SURNAME (APELYIDO) GIVEN NAME (PANGALAN) MIDDLE NAME (GITNANG PANGALAN) ADDRESS (NO. & STREET ; CITY/TOWN & PROVINCE) (TIRAHAN: BILANG AT KALYE, LUNGSOD/BAYAN AT LALAWIGAN) POSTAL CODESEXMALEFEMALEDATE OF BIRTHCIVIL STATUSSINGLEMARRIEDWIDOWED (LALAKI)(BABAE)(KAPANGANAKAN)(KATAYUANG SIBIL)(WALANG ASAWA)(MAY ASAWA)(BALO) mdyymd BENEFICIARIES (MAKIKINABANG)  SPOUSEFATHER (ASAWA)(AMA) MOTHER (INA) CHILDRENDATE OF BIRTH (MGA ANAK)(KAPANGANAKAN) OTHER BENEFICIARIES  (IF WITHOUT SPOUSE, CHILD OR PARENT)(IBANG MAKIKINABANG: KUNG WALANG ASAWA, ANAK, O MAGULANG) NAMERELATIONSHIP (PANGALAN)(RELASYON) 12345123 THUMB PRINT LEFTRIGHT (KALIWA)(KANAN) I hereby certify that the above information are (Ako ay nagpapatunay na ang aking mga isinaad ay totoo at tama) true and correct. Signature (Lagda) mmddyy    ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○       ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○    ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○       ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○ Cut along the dotted line.Please read reminders on page 2 of this form. Internet Edition (7/2000)  INSTRUCTIONS 1. Submit this form in two copies together with the srcinal/certified true copy andphotocopy of the following supporting documents: PRIMARY DOCUMENTS - Birth Certificate; or- Baptismal Certificate; or- Passport OTHER REQUIRED DOCUMENTS For reporting spouse - Marriage ContractFor reporting child -If legitimate:Birth or Baptismal CertificateIf illegitimate:Birth or Baptismal Certificate or in its absence,Proof of Parentage or RelationshipIf legally adopted:Decree of AdoptionIn the absence of any of the primary documents, submit any two of the followingwhere the name and date of birth of the registrant appear: SECONDARY DOCUMENTS - Record of Employment/Employer ID- GSIS Member’s Record- Certification from National Archives- Alien Certificate of Registration- School/Voter’s Identification Card- Driver’s License- Marriage Contract- Birth Certificate of children- Joint Affidavit of two disinterested persons attesting to the correct name & date ofbirth of the applicant2. If the above-stated documents are not available at the time of registration, complyimmediately by submitting to the nearest SSS office to facilitate availment ofbenefits and privileges. REMINDERS 1. Issuance of SS number does not automatically qualify you for coverage. You mustfirst be engaged in an occupation subject to SSS coverage.2. An SS number is a lifetime number. No one should have more than one SS number.
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