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Sss form sickness application 2026

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  1. Click ‘Get Form’ to open the SSS Form Sickness Benefit Reimbursement Application in the editor.
  2. Begin by filling in the employer's registered name and ID number in sections 1 and 2. Ensure accuracy as this information is crucial for processing.
  3. In section 4, enter the employee's full name and Social Security Number (SS No.) in section 5. This identifies the individual applying for benefits.
  4. Complete sections 6 through 8 with the employee's address, date of coverage, and specific dates related to their sickness or injury.
  5. For sections 9 through 12, provide details about confinement dates, sick leaves paid, and compute the sickness benefits using the guidelines provided on the form.
  6. Finally, ensure that both the employee and employer representative sign in section 13 to certify that all information is accurate before submitting.

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sss sickness benefit application form

Application for Sickness Benefits - SI-1a (03-12)

A. Furnish the name and complete address of the person or company. Name. Address. City, State, ZIP Code. B. Give the place where the injury occurred.

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