3.08.2014

Affidavit of Separation from Employment

By KD

Updated February 10, 2016

If your former employer refuses to issue you a Certificate of Separation or Non-Advancement of SSS Maternity Benefit, you can now use this SSS-created affidavit form AFFIDAVIT OF UNDERTAKING to complete your requirements to claim your SSS maternity benefit.

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Gamitin na yong bagong form ng SSS na Affidavit of Undertaking; huwag na itong sample below.  :)
 
Here is a sample Affidavit of Separation from Employment that you can use
. when your previous company has already closed,
. or when you can no longer find your previous employer,
. or when your previous employer refuses to give you a Certificate of Separation

You can use this Affidavit as one of your documents for claiming your SSS Maternity Benefit, or for other purposes. Just change the portions of the Affidavit that do not apply to your situation. Add information if needed.

To save time and affidavit cost, ask first your SSS branch if you can submit an Affidavit of Separation from Employment instead of a separation certificate from your former employer, as you will spend 200 pesos or more for this Affidavit. Explain to the SSS officer why you cannot submit a Certification of Separation from Employment.


   AFFIDAVIT OF SEPARATION FROM EMPLOYMENT

I, __________, of legal age, single (or married), Filipino and presently residing at __________________, after having been sworn to in accordance with law hereby depose and state:

1.  That I am an active member of the Social Security System with SSS number _______________________

2.  That I was separated from my last employer, ________, with address at _________ on __________ .

3.  That I cannot secure a Certificate of Separation from Employment, L501 form and Certificate of Non-advancement of Maternity Benefit from my last employer because ________________________

4.  That my previous employer did not advance any maternity benefit to me, and that I did not receive any advance maternity benefit from my previous employer

5.  That I am executing this affidavit to attest to the truth of the foregoing facts and to support my claim for my SSS maternity benefit.



                                                     ________________
                                                                Affiant


SUBSCRIBED AND SWORN TO BEFORE ME this _____________ day of _____ 20___ in _____City, Philippines, affiant having exhibited to me his/her Residence Certificate No. ___________________ _______________ issued in _________________________ on ________
20_________.


                                                     ________________ 
                                                      Notary Public
                                                      Until December 31, ___
                                                      PTR No. _______
                                                      Issued at _______
                                                      Issued on _______

DOC NO. ____________
PAGE NO. ____________
BOOK NO. ____________
SERIES OF ____________



Note About Residence Certificate or Cedula or Other Identification Cards or Documents:

Based on the 2004 Rules on Notarial Practice issued by the Supreme Court in July 2004, you can now use ID Cards with photo and signature instead of a cedula to support your affidavits. The following IDs can be used:

. SSS ID
. GSIS ID
. Voter's ID
. Passport
. PRC ID
. Postal ID
. Driver's License
. NBI Clearance
. Barangay Certification
. Police Clearance
. Senior Citizen ID
. OWWA ID
. Seaman's Book
. DSWD Certification
. NCWDP Certification
. Alien Certificate of Registration
. Immigrant Certificate of Registration

SAMPLE SSS CERTIFICATE of SEPARATION from EMPLOYMENT

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