CERTIFICATE of SEPARATION from EMPLOYMENT

This is to certify that Susan Masipag who has been employed since April 4, 2008
by our company XYZ Co., with address at 123 Masaya St., Makati City, was
separated from our employ on September 8, 2013.
This certification is issued upon her request for the processing of her maternity
benefit claim with the SSS.

Name and Signature of

Authorized Company
Representative
Designation/Position of
Authorized Representative
Date Signed

Reminder:
Only one and the same person should sign these 3 documents and the
signatures should be the same:
Certificate of Separation from Employment
Certificate of Non-Advancement of SSS Maternity Benefit
L-501 Form (2 copies)
NOTE: If your company has closed down, and you can no longer find the
owners, ask SSS if you can submit instead an Affidavit of Separation from
Employment. SSS usually checks its records if your former company has
indeed closed down.