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NW-1 Non - Working Spouse Record
SSS member application form for non - working spouse
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DATE OF BIRTH
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(KAPANGANAKAN)
y
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m m d d y
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(GITNANG PANGALAN)
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(SEPT. 95)
MIDDLE NAME
(PANGALAN)
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GIVEN NAME
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Please print all information & use black ink only
(Isulat nang malinaw ang lahat ng impormasyon
at gumamit lamang ng itim na tinta)
(APELYIDO)
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NW-1
NON-WORKING SPOUSE RECORD
SURNAME
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SOCIAL SECURITY SYSTEM
SS NUMBER
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MALE
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(LALAKI)
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ADDRESS (NO. & STREET; CITY/TOWN & PROVINCE)
POSTAL CODE SEX
(TIRAHAN, BILANG AT KALYE; LUNGSOD/BAYAN AT LALAWIGAN)
(KASARIAN)
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FEMALE
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(BABAE)
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BENEFICIARIES (MAKIKINABANG)
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FATHER (AMA)
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TO BE FILLED BY WORKING SPOUSE
(PUPUNAN NG ASAWANG NAGHAHANAPBUHAY)
NAME OF WORKING SPOUSE (PANGALAN NG ASAWANG
NAGHAHANAPBUHAY)
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MOTHER (INA)
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SS NUMBER
CHILDREN (MGA ANAK)
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y
3
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m m d d y
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I certify that my spouse devotes full time in our
household management and I agree to my spouse’s 1
membership with the SSS.
(Aking pinatutunayan na ang asawa ko ang namamahala 2
ng gawaing pambahay sa buong panahon at sumasang-ayon
din ako sa kaniyang pagiging kasapi ng SSS.)
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DATE OF BIRTH
(KAPANGANAKAN)
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CERTIFICATION (KATUNAYAN)
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4
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5
WORKING SPOUSE’S SIGNATURE (LAGDA)
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NON-WORKING SPOUSE’S
MONTHLY SALARY CREDIT
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P
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(Ako ay nagpapatunay na ang aking mga isinaad ay totoo.)
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FOR SSS USE
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I certify that the above information are true.
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DATE RECEIVED
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START PAYING THE AMOUNT OF P_____________________
ON
NON-WORKING SPOUSE’S THUMB PRINTS
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NON-WORKING SPOUSE’S SIGNATURE (LAGDA)
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DATE APPROVED (DOC)
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RIGHT (KANAN)
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LEFT (KALIWA)
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Please read reminders on page 2 of this form.
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Cut along the dotted line.
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Internet Edition (7/2000)
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INSTRUCTIONS
1. Submit this form in two copies together with the original/certified true copy and
photocopy of the following supporting documents:
PRIMARY DOCUMENTS
- Birth Certificate; or
- Baptismal Certificate; or
- Passport
OTHER REQUIRED DOCUMENTS
For reporting spouse - Marriage Contract
For reporting child If legitimate:
Birth or Baptismal Certificate
If illegitimate:
Birth or Baptismal Certificate or in its absence,
Proof of Parentage or Relationship
If legally adopted:
Decree of Adoption
In the absence of any of the primary documents, submit any two of the following
where the name and date of birth of the registrant appear:
SECONDARY DOCUMENTS
- Record of Employment/Employer ID
- GSIS Member’s Record
- Certification from National Archives
- Alien Certificate of Registration
- School/Voter’s Identification Card
- Driver’s License
- Marriage Contract
- Birth Certificate of children
- Joint Affidavit of two disinterested persons attesting to the correct name & date of
birth of the applicant
2. If the above-stated documents are not available at the time of registration, comply
immediately by submitting to the nearest SSS office to facilitate availment of
benefits and privileges.
REMINDERS
1. An SS number is a lifetime number. No one should have more than one SS number.
2. Your monthly contributions shall be equivalent to 50% of your working spouse’s latest monthly
salary credit.
3. In case of death, retirement, permanent disability or separation from employment of your
working spouse, you may continue your membership with the SSS by applying as a voluntary
paying member.
