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DEATH CLAIM APPLICATION. (04-2012) PART I. Please read the instructions at the back of the form before filling-up the application. Print information in capital letters and use black ink only. SS NUMBER.
AFFIDAVIT FOR DEATH BENEFIT CLAIM. I, ________________, of legal age, single/married and presently residing at _______________________________ having been sworn according to law, depose and say: That I am the __________ of the late ____________________, who died at ____________________________ on _____________________________________.
Claimants must be issued an SS Number and registered in the SSS website to be able to apply for funeral benefit through the My.SSS portal. Claimant must have a disbursement account enrolled in the Disbursement Account Enrollment Module (DAEM) of the My.SSS portal in the SSS website.
Learn how to file a death claim with the SSS. This guide provides step-by-step instructions, required documents, and helpful tips for a smooth process.
Death Claim: Beneficiaries of a deceased member must use this form to apply for SSS death benefits. Funeral Claim : This form allows beneficiaries to claim funeral benefits for the costs associated with the member’s passing.
Province of ____________________) SSS FORM CLD - 1.3 A. AFFIDAVIT FOR DEATH BENEFIT CLAIM. I, ________________, of legal age, single/married and presently residing at. _______________________________ having been sworn according to law, depose and say:
1. Accomplish Parts I and II of this form in one (1) copy without erasures or alterations. 2. Support date of birth, marriage or death with birth/baptismal certificate, marriage contract or death certificate (original duplicate/certified true copy/certified photocopy) duly registered with the National
