Electronic R-3 File Generator
  R3 File Generator 2023
  HHandEELibrary.zip

Printable Forms

Registration and Membership

Member Forms
  Personal Data Record
  Member’s Data Change Request
  Kasambahay Unified Registration Form
  Request/Verification Form
  Data Privacy Consent Form
(Updating of Contact Information of Members including Prior Registrants Based Abroad through OFW Contact Services Section) 

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

Contributions
  Contribution Collection List
  Contributions Payment Return
  Miscellaneous Payment Return

Member Loans
  Real Estate Loan Payment Return
  Application for Housing Loan
  Educational Assistance Loan Program
  Application for Option to Sell Shares of Stock (SILP/PFLP)
  Request For Processing Of Short-term Member Loans Overpayment

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)

Maternity Benefit
  Maternity Benefit Application/Matenity Benefit Reimbursement Application (Special Cases)
  Maternity Notification
  Affidavit of Undertaking – Non Receipt of Advance Payment for Sickness/Maternity Benefits
  Affidavit of Undertaking – Unclaimed Maternity Benefit of Deceased Member

Retirement Benefit
  Retirement Claim Application
  Member’s Claimant’s Photo & Signature Card Form
  Affidavit of Separation from Employment/Cessation of Self-Employment with Undertaking
  Application for representative payee (CLD 1.5) – In case guardian is other than parent/member
  Guarantor’s Bond Form (BPN 107) – In case guardian is other than parent/member
  Claims for dependent’s pension (BPN 106) – This form must be submitted if dependent child is under the guardianship by the parent other than the member

Disability Benefit
  Disability Claim
  Employment Data Form
  Medical Certificate

Death Benefit
  Death Claim Application
  Member’s Claimant’s Photo & Signature Card Form
  Joint Affidavit of two disinterested person (CLD 1.3)
  Report of Death (BPN 105)
  Guarantor’s Bond Form (BPN 107)

Funeral Benefit
  Funeral Claim
  Affidavit of Funeral Expenses
  Waiver (SS Funeral Benefit)
  Joint Affidavit of Two Disinterested Persons

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)
  Pensioner’s Data Change Request Form

EC Benefits
  EC Medical Reimbursement Benefit Application
  EC Accident/Sickness Report
 

Flexi Fund Program
  Early Withdrawal Claim Form

P.E.S.O Fund Program
  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

Freedom of Information
  FOI Request Form

Member Concern
  Tagalog Sinumpaang Salaysay For Authorized Representative (MCA-01620)
  Tagalog Sinumpaang Salaysay para sa Miyembro (MCA-01619)
  English Sinumpaang Salaysay For Authorized Representative (MCA-01618)
  English Sinumpaang Salaysay (MCA-01617)
  Customer Information Form (MCA-01616)
  Personal Data Sheet
  Specimen Signature

Supplementary Form for Benefit Claim Application
  Certification Undertaken by the Representative Payee of a Person Deprived of Liberty
  Special Power of Attorney Undertaken by the Person Deprived of Liberty