Electronic R-3 File Generator
R3 File Generator 2023

 

Printable Forms

Registration and Membership

-Member Forms
Personal Data Record
Member’s Data Change Request
Unified Multi-Purpose ID (UMID) Card Application Form
Kasambahay Unified Registration Form
Request/Verification Form

-Employer-Member Forms
Employer Registration Form
Employment Report
Employer Data Change Request
Household Employer Unified Registration Form
Household Employment Unified Report Form

–Application for Special Programs
Sickness and Maternity Benefits Payment thru the Bank Form

Contributions
Contribution Collection List
Contributions Payment Return
Miscellaneous Payment Return

Member Loans
Member Loan Application
Monthly-Salary/Calamity/Educational/Emergency/Stock Investment Loan Payment Return
Real Estate Loan Payment Return
Educational Assistance Loan Program
Application for Direct House Repair and/or Improvement Loan
Application for Option to Sell Shares of Stock (SILP/PFLP)

  • Special Power of Attorney-Option to Sell Shares of Stock (SILP/PFLP)
Calamity Loan Assistance Application Form

Benefit Applications
DDR Application Form under Portability Law
Certification

-Sickness Benefit
Sickness Notification Form
Sickness Reimbursement Form
Sickness Benefit Application Form (for Unemployed/Self-Employed/Voluntary)
Medical Certificate
EC Medical Reimbursement Application Form 1
EC Medical Reimbursement Application Form 2
ECMED Evaluation Sheet
Employer Transmittal List (Sickness Benefit Reimbursement Application)
Transmittal List(Sickness Benefit Application)
Affidavit of Undertaking (English)
Affidavit of Undertaking (Tagalog)
Affidavit of Undertaking (Visayan Version)

-Maternity Benefit
Maternity Benefit Application
Maternity Notification
Allocation of Maternity Leave Credits Form
Maternity Reimbursement
Transmittal List (Maternity Benefit Application)
Employer Transmittal List (Maternity Benefit Reimbursement Application)
Affidavit of Undertaking (English)
Affidavit of Undertaking (Tagalog)
Affidavit of Undertaking (Visayan Version)

-Retirement Benefit
Retirement Claim
Affidavit of Separation from Employment

-Disability Benefit
Disability Claim
Employment Data Form
Medical Certificate

-Death Benefit
Death Claim
Affidavit for Death Claim Benefits

-Funeral Benefit
Funeral Claim
Affidavit of Funeral Expenses
Sinumpaang Salaysay (Pinagbayaran sa Pagpapalibing)
Waiver (SS Funeral Benefit)
Pagpapaubaya (SSS Funeral Benefit)

-Annual Confirmation of Pensioners
Annual Confirmation of Pensioners (For Retirement or Permanent Total Disability Pensioner)
Annual Confirmation of Pensioners (For Surviving Legal Spouse Pensioner)
Annual Confirmation of Pensioners (For Representative Payee of Dependent (Minor/Incapacitated) Child)
Annual Confirmation of Pensioners Video Conference
Pensioner’s Data Change Request Form
Self-Declaration Form of Survivor Pensioner on Non-Remarriage/Non-Cohabitation

-EC Benefits
EC Claim for Temporary Total Disability or Sickness
EC Medical Reimbursement Benefit Application
EC Accident/Sickness Report

Flexi Fund Program
Flexi Fund Enrollment Form
Early Withdrawal Claim Form

P.E.S.O Fund Program
SSS P.E.S.O. Fund Enrollment Form
SSS P.E.S.O. Fund Payment Form
SSS P.E.S.O. Fund Amendment Form
SSS P.E.S.O. Fund Withdrawal Form
SSS P.E.S.O. Fund Retirement Benefit Claim Form
SSS P.E.S.O. Fund Total Disability Benefit Claim Form
SSS P.E.S.O. Fund Death Benefit Claim Form

Supplementary Forms
Specimen Signature Card
Sinumpaang Salaysay
Member’s/Claimants Photo and Signature Card

Freedom of Information
FOI Request Form

Member Concern
Sinumpaang Salaysay For Authorized Representative (mca-01620)
Sinumpaang Salaysay para sa Miyembro (mca-01619)
Sinumpaang Salaysay For Authorized Representative (mca-01618)
Customer Information Form (mca-01616)
Sinumpaang Salaysay (mca-01617)