Data Input

Member Basic Information

SS NUMBER MEMBER'S NAME (Last Name, First Name Suffix Middle Name)
33-2117791-0 VELUZ, MELODY COLLADO
DATE OF BIRTH(mm/dd/yyyy) DATE OF COVERAGE(mm/dd/yyyy) MEMBERSHIP TYPE
05/10/1971 07/01/1999 Voluntary paying
HOME ADDRESS

Online Correction (Check appropriate box/es ONLY IF there is/are change/s.)

MAILING ADDRESS
ZONE 3 SANTO NIÑO 2ND SAN JOSE CITY NUEVA ECIJA 3121
FOREIGN ADDRESS

TELEPHONE NUMBER (Area Code + Tel No.)

MOBILE NUMBER
0922-566-1938
EMAIL ADDRESS
otilracz@zoho.com

Note : To receive notifications from SSS, please enter your email address and/or mobile number
Employee Static Information

C.R.N.
Member
SS Number 33-2117791-0 VELUZ, MELODY COLLADO
Name
Date of
Date of Birth 05-10-1971 07-1999
Coverage

 Member Info
 Benefit
 SMEC
 Loans
 Premium Payments
 Eligibility
 Documents

Member Details
Sex: F
Reporting Date: 07-01-1999
Reporting ID: 02-0912854-7
Latest ER ID: 88-8888800-6
Latest ER Name:
Claim Flag Status: NO CLAIM
SS Number Status: SS NUMBER ACTIVE
Transferred to (New SS Number):
Coverage Status: VOLUNTARY MEMBER
Change in Coverage Status: FROM COVERED EMPLOYEE TO VOLUNTARY MEMBER
Date of Loan Disqualification:
SS Number Withdrawal Reason:
Record Location: TARLAC

Address & Contact Information

Local Home Address :
Local Mailing Address : ZONE 3 SANTO NIÑO 2ND SAN JOSE CITY NUEVA ECIJA 3121
Landline :
Mobile :
Email Address : otilracz@zoho.com
Foreign Home Address :
Foreign Mailing Address :

Social Security System

Web On-line Inquiry System
Copyright © 2002
Contributions - Actual Premiums

C.R.N.

Member
SS Number 33-2117791-0 VELUZ, MELODY COLLADO
Name

Date of
Date of Birth 05-10-1971 07-1999
Coverage

 Member Info
 Benefit
 SMEC
 Loans
 Premium Payments
 Eligibility
 Documents

Monthly Premiums

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2015 0.00 0.00 0.00 0.00 385.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2013 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 364.00 0.00 0.00
2005 282.00 282.00 282.00 282.00 282.00 282.00 282.00 282.00 282.00 0.00 0.00 0.00

2004 282.00 282.00 282.00 282.00 282.00 282.00 282.00 282.00 282.00 282.00 282.00 282.00

2003 84.00 84.00 94.00 94.00 94.00 94.00 94.00 94.00 94.00 282.00 282.00 282.00

2002 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00

2001 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00

2000 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00 84.00

1999 0.00 0.00 0.00 0.00 0.00 0.00 84.00 84.00 84.00 84.00 84.00 84.00

Summary

(A) Total Number of Contributions Displayed 77

(B) Total Number of Contributions not Displayed 0

Total Number of Contributions Posted (A) + (B) 77

Total Amount of Contributions 11,871.00

Employment History

C.R.N.

Member
SS Number 33-2117791-0 VELUZ, MELODY COLLADO
Name

Date of
Date of Birth 05-10-1971 07-1999
Coverage

Employer Id Name Reporting Date Employment Date

88-8888800-6 11-2013 10-2013

02-0912854-7 C.T.IGNACIO PHARMACY 07-1999 07-1999

SSS Id Clearance

C.R.N.

Member
SS Number 33-2117791-0 VELUZ, MELODY COLLADO
Name

Date of Birth 05-10-1971 Date of 07-1999

 Coverage

SSS ID Card Production Information

Card Serial No./Job No : 0411101359

P.O. Number :

C.R.N. :

Captured Member's Name : MELODY COLLADO VELUZ

Card Type : SSS ID CARD

Mailing Address : 780 RAMOS EXT SIBUT SAN JOSE CITY NUEVA ECIJA 3121

Capture Site : CABANATUAN

Station ID : b4idd01
Checklist of Documentary Requirements Maternity Benefit Application for Self-Employed/Voluntary Member and Members
Separated from Employment

Maternity Benefit Application (MBA)

Maternity Notification (MN) duly received by SSS prior to delivery/miscarriage/procedure or
"Maternity Notification Submission Confirmation" (if filed thru the SSS Web or SSIT)
Present the original/certified true copy and submit the photocopy of the following whichever is
applicable:

For Normal delivery

Childs birth or fetal death certificate duly registered with the Local Civil Registrar(LCR)
Certificate of Length of Service certified by employer; and

For Caesarean Delivery

Childs birth or fetal death certificate duly registered with the Local Civil Registrar(LCR); and
Any of the following documents issued by the hospital indicating the type of delivery;
A. Operating Room Record (ORR)
B. Surgical Memorandum
C. Discharge Summary Report
D. Medical/Clinical Abstract
E. Delivery Report
F. Detailed Invoice showing caesarean delivery charges, for deliveries abroad only

For Complete Miscarriage

Obstetrical History indicating the number of pregnancy/ies duly certified by attending physician
with his/her Professional Medical License number with printed name and signature; and
Any of the following documents issued by the hospital indicating the type of delivery;
A. Pregnancy test before and after miscarriage
B. Ultrasound report indicating proof of pregnancy
C. Medical Certificate issued by attending physician on the circumstances of pregnancy

For Incomplete Miscarriage

Obstetrical History indicating the number of pregnancy/ies duly certified by attending physician
 with his/her Professional Medical License number with printed name and signature; and
Any of the following:
A. Certified true copy of hospital/medical record/s
B. Dilation & Curettage (D & C) report
C. Histopathological report
D. Pregnancy test before and after miscarriage
E. Ultrasound report indicating proof of pregnancy

For Ectopic Pregnancy

Obstetrical History indicating the number of pregnancy/ies duly certified by attending physician
with his/her Professional Medical License number with printed name and signature; and
Any of the following:
A. Certified true copy of hospital/medical record/s
B. Certified true copy of ORR
C. Histopathological report
D. Pregnancy test before and after miscarriage

For Hydatidiform Mole (All of the following :)

Obstetrical History indicating the number of pregnancy/ies duly certified by attending physician
with his/her Professional Medical License number with printed name and signature.
Dilation and Curettage (D & C) report
Histopathological report

Note: The Medical Specialist may require other documents necessary for the evaluation of the claim (for miscarriage/ectopic/H-Mole
cases) For deliveries/miscarriages that happened abroad, documents issued by foreign country should be with English translation and
duly authenticated by the Philippine Embassy/Consulate Office or duly notarized by notary public in host country.

Additional required documents, present the original/certified true copy and submit the photocopy of
the following, whichever is applicable:

For Self-Employed and Voluntary Members (previously employed)

If delivery/miscarriage/procedure is within employment period or within six (6) months from
date of separation