From:

NAME OF AUTHORIZER
ADDRESS
ADDRESS 2

To:

Republic of the Philippines

Social Security System
3F Puregold Bldg. Gen. Roxas
Cubao, Quezon City

Re: Authorization to file funeral claim application and death claim application

I, the undersigned, wish to process a funeral claim application and benefit claim. Since it is impossible to
apply personally in your office due health concern, I hereby authorized to
act on my behalf in all manners relating to securing, preparation, file and overall processing of
documents.

I provided a copy of my Identification card to attest this authorization.

Thank you very much for your kind consideration.

Sincerely yours,

NAME OF AUTHORIZER