sss.gov.ph Apply for Medical Certificate Philippines : Social Security System

Organization : Social Security System
Type of Facility : Apply for Medical Certificate
Country: Philippines
Website : https://www.sss.gov.ph/sss/appmanager/portal/home
Download Form : https://www.statusin.org/uploads/7200-DownloadContent.pdf

SSS Apply for Medical Certificate

(SSS FORM MMD – 102)

Related / Similar Service : SSS Online Registration Philippines

1. Employee’S General Data:
Name (Last, First, M.I.)
Age
Sex
Civil Status
Occupation

Date Examined/Attended:
From
To

2. Brief Clinical History And Present Physical Findings (Attach Extra Sheet If Needed)

3. X-Ray Laboratory And/Or Special Diagnostic Examination (Attach Extra Sheet If Needed)

4. Final Diagnosis

5. Exact Date Of Disability

6. Kind Of Surgical Operation Performed, If Any (If Claim Is For Disability Attach Operating Room Record)

7. Date Of Operation

8. Period Of Medical Attendance/ Treatment/Actual Sickness:
From
To

Convalescing Or Recuperation Period:
From
To

Place Or Places Where The Patient Was Confined During My Medical Attendance And/Or Treatment:
Place/S Of Confinement
Date From To

9. Other Remarks:
Pursuant To Section 28 Of The Social Security Law, As Amended, Anyone Who Resorts To Misrepresentation Or Concealment Of A Material Fact Or Who Is A Party Thereto, For The Purpose Of Causing Any Payment Of Fraudulent Claim Or Benefit Under The Said Law, Shall Suffer The Penalties Of Fine Or Imprisonment Or Both.

I Hereby Warrant That I Have Thoroughly Examined The Herein Patient/Claimant And That The Foregoing Information Are True And Correct.

Physician’S Signature Over Printed Name

License/Certificate No.

Date Of Accomplishment

Address

Statement Of Waiver:
I Hereby Waive Any Right Or Privilege I May Have On All Information Pertaining To My Medical History And I Consent To Allow Sss To Examine All My Medical Records.

Right Or Left Thumbprint Of Patient/Claimant If Illiterate Or Unable To Write

Patient’S/Claimant’S Signature

FAQ :
When a person has secured an SS number, does it mean that he/she is already a covered SSS member and therefore, has the right to social security benefits?
Issuance of SS number does not immediately qualify you for coverage or benefits. You must first be employed in an occupation subject to and reported for SSS coverage.

However, once you become a covered SSS member, you become a member for life. The contributions that you remit become savings for the future that will serve as basis for the granting of social security benefits in times of contingencies. Membership cannot be withdrawn and contributions paid cannot refunded.

What should I do if there are changes in my personal record?
Changes in your record should be reported immediately to the nearest SSS office through the submission of Member’s Data Change Request (SS Form E-4) and the required supporting documents :
** Change of civil status from Single to Married – Marriage contract

** Change of civil status from Married to Single – Death certificate (if due to death of previously reported spouse); Certificate of Finality of Annulment or Decree of Divorce
** New/additional/change of dependents/beneficiaries – Birth or Baptismal Certificate(s) of children or marriage contract for spouses
** Correction of name/date of birth – Birth or Baptismal Certificate or unexpired Passport

What is the effect of non-reporting and non-remittance of contributions?
To the Employee :
** The employee is still entitled to SS benefits even if the employer fails or refuses to remit the SSS contributions.

To the Employer :
** An employer who does not report temporary or provisional employees is violating the SS law.

The employer is liable to the employees and must:
** pay the benefits of those who die, become disabled , get sick or reach retirement age;
** pay all unpaid contributions plus a penalty of three percent per month; and
** be held liable for a criminal offense punishable by fine and/or imprisonment.

** To the Self-employed Person and Voluntary Member

** A self-employed person who fails to register with the SSS may be subjected to fines and/or imprisoned. However, in the event the self-employed or voluntary member does not realize earnings in a given month, payment of SSS contributions for that month is no longer required.

** Self-employed and voluntary members may pay their monthly contributions prospectively or in advance, but never retroactively to cover month/s when no contribution payments were remitted.

** In the case of the covered Non-Working Spouse, if he/she later becomes employed, self-employed or an OFW, the membership shall be reclassified accordingly as employed or self-employed or OFW.