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DDR-2 DEATH, DISABILITY, RETIREMENT AND EARLY WITHDRAWAL CLAIM
SSS form used for flexi - fund withdrawal claim
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
DDR-2
(REV. 05-01)
SOCIAL SECURITY SYSTEM
DEATH, DISABILITY, RETIREMENT AND EARLY WITHDRAWAL CLAIM
(FLEXI-FUND PROGRAM)
(Please read instructions at the back, Print all information in capital letters & use blank ink only)
MEMBER'S NAME (SURNAME)
MEMBER'S SS NUMBER (must be 10 digits)
ADDRESS
(BARANGAY)
(NUMBER & STREET)
DATE OF BIRTH (MM/DD/YYYY)
(GIVEN NAME)
LUMPSUM
DISABILITY
NO. OF YEARS
EARLY WITHDRAWAL
DEPENDENT CHILDREN
DATE OF BIRTH
(Beginning from the youngest)
(MM/DD/YYYY)
CLAIMANT'S NAME
(GIVEN NAME)
LUMPSUM: P
NO. OF YEARS
OF PENSION:
Check Applicable Column
LEGITIMATE
ADDRESS
ILLEGITIMATE
ACCOUNT NUMBER
BANK ADDRESS
(SURNAME)
BOTH
PENSION
Indicate the no. of years
RETIREMENT
NAME OF BANK/BRANCH
POSTAL CODE
BENEFIT OPTION (Check option)
DEATH
TELEPHONE NO.
(CITY/PROVINCE)
(TOWN/DISTRICT)
CLAIM TYPE
(MIDDLE NAME)
(MIDDLE NAME)
BRSTN (SSS to fill in this portion)
DATE OF BIRTH (MM/DD/YYYY)
RELATIONSHIP TO MEMBER
Photo
1x1
Signature of Claimant
Date
WITNESSES TO FINGERPRINTS (If claimant cannot sign)
1.
Signature Over Printed Name
Date
2.
Signature Over Printed Name
REMARKS
NO OTHER
CLAIM FILED
RIGHT THUMBMARK
Date
FOR SSS USE ONLY
CLEARED/DATE
RECEIVED/DATE:
Signature Over Printed Name
SOCIAL SECURITY SYSTEM
ACKNOWLEDGEMENT RECEIPT
DEATH, DISABILITY, RETIREMENT,
AND EARLY WITHDRAWAL CLAIM
(FLEXI-FUND PROGRAM)
MEMBER'S SS NUMBER (must be 10 digits)
MEMBER'S NAME (SURNAME)
RIGHT INDEX
(GIVEN NAME)
Signature Over Printed Name
PLEASE PRESENT THIS WHEN INQUIRING
ABOUT THE STATUS OF YOUR APPLICATION.
VERIFICATION WILL BE ENTERTAINED AFTER
_______ DAYS FROM THE DATE OF RECEIPT
(MI)
FOR SSS USE ONLY
DATE RECEIVED
RECEIVED BY
GENERAL INSTRUCTIONS
1. Accomplish this form in one (1) copy without erasures or alterations.
2. If claimant cannot sign, affix right thumbmark and right index on the spaces provided and must be
identified by two (2) witnesses.
3. If the benefit option selected is pension, submit photocopy together with the original copy of single
savings account passbook.
WARNING
ANY PERSON WHO MAKES FALSE STATEMENTS IN THIS APPLICATION OR SUBMITS FALSIFIED
DOCUMENTS IN CONNECTION WITH HIS CLAIM SHALL BE LIABLE CRIMINALLY FOR FALSIFICATION
OF PUBLIC DOCUMENTS.
CHECKLIST OF REQUIRED DOCUMENTS AND SPECIFIC INSTRUCTIONS
DEATH
Primary Beneficiaries
Death Certificate of member
Marriage Certificate
Birth/Baptismal Certificates of minors
Medical Certificate of incapacitated child, if any
Death Certificate of spouse, if already deceased
Application for Representative Payee (CLD-15)
Guaranteed Bond Form (BPN-107)
Proof of relationship such as record of birth,
a statement before a court of record or any
authentic writing/document
-
Duly registered with Local Civil Registry Office
Duly registered with Local Civil Registry Office
Duly registered with Local Civil Registry Office/Parish Church
To be accomplished by the child's attending physician
Duly registered with Local Civil Registry Office
To be accomplished by the guardian of the minor children other than parent
To be accomplished by a guarantor, if minor children are under a guardian
To be submitted for illegitimate children
-
Duly registered with Local Civil Registry Office
Duly registered with Local Civil Registry Office/Parish Church
Duly registered with Local Civil Registry Office/Parish Church
-
To be submitted if parents are deceased
To be submitted to prove claimant's relationship with the deceased
Duly registered with Local Civil Registry Office/Parish Church
Secondary Beneficiaries
If Claimant is Parent
Death Certificate of member
Birth Certificate of deceased member
Marriage Certificate of parents
If Claimant is other than Parents
Death Certificate of parents
Birth Certificate of the deceased brother/sister
Birth Certificate of minor beneficiaries
DISABILITY
Medical Certificate (MMD-102)
Operating Room Record
Accident Report (B-309)
Other medical records that may be requested by
the Medical Benefits Section, Diliman Branch
To be accomplished by the claimant's attending physician
To be secured if claimant has been operated on
To be secured from the employer
RETIREMENT
Birth Certificate of member
-
To be submitted if with discrepancy in the date of birth
