Get Sinumpaang Salaysay Sample

Republic of the Philippines SOCIAL SECURITY SYSTEM Branch Name Address 10-2008 Name of Claimant SS No. Name of Member Checklist for Funeral Claim Benefit Funeral Claim Application Form Death Certificate of the member Filer s Affidavit Sinumpaang Salaysay Official Receipt OR issued by the funeral parlor Affidavit of funeral expenses if the service of a funeral parlor was not contracted Funeral Parlor Service Contract if the claimant has not yet settled his/her account with the funeral parlor. Signed authority or conformity of payment in favor of the claimant in case the name appearing in the receipt being submitted as proof of payment of funeral expense is different from that of the claimant. Copy of the service contract and authorization from the relative of the deceased member to apply the funeral benefit claim to the actual cost of funeral service if the claimant is the funeral parlor Certification from the insurance/memorial plan company stating that the deceased is the plan holder. Signed authority or conformity of payment in favor of the claimant in case the name appearing in the receipt being submitted as proof of payment of funeral expense is different from that of the claimant. Copy of the service contract and authorization from the relative of the deceased member to apply the funeral benefit claim to the actual cost of funeral service if the claimant is the funeral parlor Certification from the insurance/memorial plan company stating that the deceased is the plan holder. Affidavit executed by the plan holder and the memorial plan company together with the memorial plan wherein the memorial plan holder allows the transfer of the plan to the deceased member Marine protest and passenger s manifest for member passenger for member who died in a sea mishap without recovering the body Coast guard report for member-fisherman Accident Report/Report of Death SS Form BPN-105 Screener Code Page 2 of 2 Police investigation report conducted after the disappearance and confirmation report from police or other government agency after 4 or 7 years from the date of disappearance Deed of Sale in case the name in the memorial plan is not the claimant Joint affidavit of two 2 disinterested persons attesting to the fact if such is the case that and are one and the same person stating therein the correct name. Recent residence certificate of the filer Latest 1 x 1 picture of claimant/filer Identification cards of claimant/filer at least two 2 one with photo for company ID Senior Citizen s ID Police or NBI Clearance Voter s ID etc* or one 1 ID for SSS Digitized passport PRC Cars Seaman s Book and Driver s License. Others FOR SSS USE SCREENED BY SIGNATURE OVER PRINTED NAME SC01 DATE SC03 SC02 SC04 NOTE 1. Death certificate and marriage contract should be duly registered with the National Statistics Office/Local Civil Registrar Office and the baptismal certificate by the Parish/Church. Copy of the service contract and authorization from the relative of the deceased member to apply the funeral benefit claim to the actual cost of funeral service if the claimant is the funeral parlor Certification from the insurance/memorial plan company stating that the deceased is the plan holder. Affidavit executed by the plan holder and the memorial plan company together with the memorial plan wherein the memorial plan holder allows the transfer of the plan to the deceased member Marine protest and passenger s manifest for member passenger for member who died in a sea mishap without recovering the body Coast guard report for member-fisherman Accident Report/Report of Death SS Form BPN-105 Screener Code Page 2 of 2 Police investigation report conducted after the disappearance and confirmation report from police or other government agency after 4 or 7 years from the date of disappearance Deed of Sale in case the name in the memorial plan is not the claimant Joint affidavit of two 2 disinterested persons attesting to the fact if such is the case that and are one and the same person stating therein the correct name.