ACKNOWLEDGEMENT OF M ATERNITY BENEFIT ADVANCE

(Maternity Benefit)

I, (FULL NAME), hereby acknowledge this notification from TeleTech Customer Care Management
Phils., Inc., / TeleTech Customer Care Philippine Branch / TeleTech Philippines ROHQ / Motif
Limited – Philippine Branch (collectively referred to as “TeleTech”) that:

1. Upon confirmation of my pregnancy, I will submit the duly accomplished SSS Maternity
Notification Form to Human Capital. Teletech shall, thereafter, inform SSS of the
Maternity Claim.

2. I understand that the Maternity Benefit cash advance shall be credited to my payroll account
within 30 business days from the submission of the SSS Maternity Benefit Application Form
together with the complete documentary requirement and approval of the Maternity Leave
application.

a. Documentation Required for Maternity Leave Filing / Mat Claim (1)

• Duly accomplished SSS Maternity Reimbursement Form
• Latest Ultrasound report and result
• Duly accomplished Acknowledgement of Maternity Benefit Advance form
• Email Acknowledgment of Leave Notice from immediate Line Manager on
maternity leave request

b. Failure to comply with the above (#2) will result in non-crediting of the Maternity
Benefit Cash advance.

3. Upon the completion of my Maternity Leave, and within 30 calendar days from the last day of my
approved Maternity Leave, I undertake to submit the SSS Maternity Reimbursement Form
together with the following documents:

c. DOCUMENTATION for MATERNITY Compliance/Mat Subsidy pay-out

• Duly accomplished SSS Maternity Reimbursement Form (if there was an
update in Name, marital status or any personal/pregnancy related
information)
• Complete Obstetrical History Form (SSS Form, to be filled out by attending OB-Gynecologist)
• Updated SSS contribution print-out
• Latest Ultrasound report and result
• Fit to Work Clearance (Doctor's license number should be visible
in the medical clearance/certificate)

d. Supporting Documents for Normal / Cesarean Delivery

• Certified true copy of Child's Birth Certificate / Original PSA Birth Certificate, if late registered
• Certified true copy of Certificate of Fetal Death / Original PSA Certificate of Fetal
Death, for still birth or emergency termination of pregnancy (ETP)
• Address Sketch, for Normal delivery on maternity/lying-in clinic (should be hand-drawn)
• Certified true copy Record of Operation, for Cesarean delivery

e. Supporting Documents for Miscarriage

• Certified true copy of Dilation and Curettage (D&C) Report
• Certified true copy of Histopathological Report
f. • Official Pregnancy report or Ultrasound report before and after miscarriage

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 4. Failure to comply with the above (#3) may result in TeleTech exercising all available legal means
to collect any advances made to the employee.

5. In addition, I understand that my failure to complete the above requirements shall constitute an
accountability on my end. As such, TeleTech undertakes to recover the cash advance that I
received through payroll deduction or exercise its option to withhold exit clearance necessary to
process my Final Pay. For this purpose, I authorize the Company to make the necessary
deductions in my payslip/ final payslip all the accountabilities described in this Section 3.

6. In the event of unanticipated miscarriage or early termination of pregnancy, and I was

given maternity cash advance equivalent to the amount intended for live child birth, I am
authorizing the Company to recover the amount given to me in excess through salary
deduction or other appropriate legal channels.

7. In compliance with health and safety policies of the Company, Employees are expected to
complete their entire approved maternity leave dates. Should I return to work earlier than my
approved maternity leave, I am authorizing the Company to recover the amount equivalent to
the work days overlapping with my supposed maternity leave dates through salary deduction or
other appropriate legal channels to avoid double compensation in compliance with the EMLL IRR
Rule IV Section 2;

8. Should I be separated from the Company for cause and/or have failed to process my Maternity
Reimbursement requirements, I am authorizing TeleTech, and/or its duly authorized
representative., to collect , process, submit, retain, any and all documents that may be necessary
in order for TeleTech to process the Maternity Reimbursement with the SSS.

9. Should I be separated from the Company during the 30 day period referred to above (#3 ) and
before submission of the all required documents are made, I authorize TeleTech to deduct the
outstanding and full balance advanced as Maternity Benefit from my Final Pay. I agree that I shall
thereafter process and collect my SSS Maternity Benefits from the SSS offices directly. TeleTech
shall likewise issue the corresponding Certificate of Non-Cash Advance in my favor within seven
(7) days from date of request.

10. I understand that the Full Pay of the Maternity Benefit that I received consists of the SSS benefit
and the Salary Differential. As such, all the statutory contributions (PhilHealth, SSS and Pag-IBIG)
will be deducted from the Salary Differential portion of my Maternity Benefit.

11. I understand that should I have any existing loans with government agencies during the duration
of my Maternity Leave period, TeleTech shall not make any deductions or payments for these
loans. Instead, during the period of my Maternity Leave, I undertake to personally pay the said
loans in order to avoid the corresponding penalties associated with late payment.

CONFORME:

____________________

Employee’s Signature Over Printed Name

____________________

Acknowledgement Date

Cc: HCSS

Revised: 03/2021

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