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

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
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)

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
Filer’s Affidavit Form (Sinumpaang Salaysay)
Affidavit of Death Benefit (CLD 1.3A)
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
Sinumpaang Salaysay (Pinagbayaran sa Pagpapalibing)
Waiver (SS Funeral Benefit)
Pagpapaubaya (SSS 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)