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    Updated Mat Miscarriage Undertaking Form

    Uploaded by

    Aldrea Villanueva
    This document outlines the requirements and process for an employee to receive maternity (miscarriage) benefits from their employer Concentrix Philippines and Social Security System (SSS). [1] The employee must submit all required documents listed within 7 days of benefits being credited to have their work status reinstated. [2] These documents include medical certificates, ultrasound reports, SSS contribution records, and identification documents. [3] The employee also consents to the deduction of advanced benefits from their salary if the SSS reimbursement is lower than advanced or denied for employee-attributable reasons.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Updated Mat Miscarriage Undertaking Form

    Uploaded by

    Aldrea Villanueva
    153 views1 page
    This document outlines the requirements and process for an employee to receive maternity (miscarriage) benefits from their employer Concentrix Philippines and Social Security System (SSS). [1] The employee must submit all required documents listed within 7 days of benefits being credited to have their work status reinstated. [2] These documents include medical certificates, ultrasound reports, SSS contribution records, and identification documents. [3] The employee also consents to the deduction of advanced benefits from their salary if the SSS reimbursement is lower than advanced or denied for employee-attributable reasons.

    Original Title

    20220616095132_updated__mat__miscarriage__undertaking_form

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    This document outlines the requirements and process for an employee to receive maternity (miscarriage) benefits from their employer Concentrix Philippines and Social Security System (SSS). [1] The employee must submit all required documents listed within 7 days of benefits being credited to have their work status reinstated. [2] These documents include medical certificates, ultrasound reports, SSS contribution records, and identification documents. [3] The employee also consents to the deduction of advanced benefits from their salary if the SSS reimbursement is lower than advanced or denied for employee-attributable reasons.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    153 views1 page

    Updated Mat Miscarriage Undertaking Form

    Uploaded by

    Aldrea Villanueva
    This document outlines the requirements and process for an employee to receive maternity (miscarriage) benefits from their employer Concentrix Philippines and Social Security System (SSS). [1] The employee must submit all required documents listed within 7 days of benefits being credited to have their work status reinstated. [2] These documents include medical certificates, ultrasound reports, SSS contribution records, and identification documents. [3] The employee also consents to the deduction of advanced benefits from their salary if the SSS reimbursement is lower than advanced or denied for employee-attributable reasons.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    EMPLOYEE MATERNITY (MISCARRIAGE) UNDERTAKING

    I, ____________________________, confirm that I am fully aware that in order for me to receive the payment of my full SSS
    Maternity Benefit provided for by applicable law and the rules from Concentrix Philippines and Social Security System, I AGREE to
    submit ALL the applicable documents listed below.

    A. SSS Maternity (Miscarriage) Requirements


    1. SSS Maternity Reimbursement form (version SIC-01242 12-2015)
    2. For Fetal Death / Stillborn Infants - Certified True Copy of Death Certificate or fetal death certificate
    3. Either of the following: Certified True Copy of Histopath, Certified True Copy of the D&C Report, Medical Certificate or
    Operations Record and Discharge Summary
    4. For Employees Hired Prior June 3, 2019: Complete OB History (accomplished by OB-Gyne, and states the number of
    pregnancies w/ exact date of delivery/miscarriage)
    5. Original Ultrasound Report with expected date of delivery (Before and After the miscarriage)
    6. Letter of explanation if no notification prior miscarriage
    7. Print out copy of updated SSS Contribution
    8. Photocopy of 2 valid IDs
    9. Three (3) specimen signatures
    10. Screenshot of SSS Employee History (reflecting Concentrix as current employer)
    11. Copy of payslip showing SSS Maternity Advances – to be submitted on the payout date

    B. Additional Documents for those with change of Name due to Marriage/Annulment (If Applicable)
    1. Employee’s Certified True Copy of Birth Certificate
    2. Marriage certificate, if married
    3. Death Certificate of spouse, if due to death of previously reported spouse
    4. Certificate of Finality of Annulment/Nullity or annotated Marriage Contract/Certificate, if due to annulled or void
    marriage with previously reported spouse
    5. Court Order on Declaration of Presumptive Death, if previously reported spouse is presumed dead
    6. Decree of Divorce and Certificate of Naturalization (granted before divorce) or its equivalent, if due to divorce with
    previously reported spouse
    7. Certificate of Divorce (OCRG Form No. 102), if due to divorce of Muslim member with previously reported spouse

    I also understand that I am required to submit ALL Maternity Documents listed and Confirm/Certify the Maternity Benefit within 7
    days from date the benefit was credited. Failure to comply with this may lead to my Workday Status not being reinstated or my
    salary being placed on hold.

    I likewise undertake and consent to allow the Company to deduct the said Maternity Benefit including the salary differential (if any)
    from my salary/final pay due to the following reasons:
    a) Social contributions for SSS, HDMF and Philhealth (including penalties and late charges in the event that the SSS benefit
    was availed after my maternity leave) advanced by the Company for the period of my Maternity.
    b) Overpayment of the Maternity Benefit (eg: SSS Reimbursement is lower than amount credited to me by the Company)
    c) SSS declines the reimbursement claim of the Company for reasons attributable to Employee.

    Finally, in case of separation from the Company and my SSS Benefit is not yet reimbursed, I understand that the amount credited to
    me by the Company will be deducted from my Final Pay and a second check will be created once the amount is reimbursed by SSS.
    Hence, I will monitor my SSS Maternity Claim via the SSS Website or Mobile App and shall provide a screenshot of the proof of
    reimbursement to HR to process the second check.

    I have read and understood the contents of this Undertaking and confirm that I fully and freely consent to all that I have
    undertaken.

    __________________________________|_________________
    Employee Signature Over Printed Name Date Signed

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