EXPANDED MATERNITY LEAVE CHECKLIST
(MATERNITY AND MISCARRIAGE WITHOUT NOTIFICATION)
Required Documents
 Fully accomplished and signed Maternity
Notification (MAT 1) Form
 Signed SSS Mat Reimbursement Form (MAT2)
with computation of Benefit using the Actual
Date of Delivery (ADD)
 Letter of explanation as to why Maternity is
not notified on time
 Signed Undertaking Form
 Photocopy of two (2) Valid IDs with signature
*Please include 3 specimen signatures on the
photocopy and make sure all signatures are identical
 Transmittal Sheet
 Stamped E4 Form (if applicable)
 Screenshot of SSS Contribution
 Record of Operation/D&C Report
 Discharge Summary and/or Medical Abstract
 Histopath
 Death Certificate (if applicable)
 SSS OB History Form
 Screenshot of Applied Leave of Absence in
Workday
 Additional Documents for those with change
of Name due to Marriage/Annulment
Signatories
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Employee’s Signature and Name/Date Signed
List of Applicable Documents/Remarks
 Employee’s Data fully accomplished
 Employer’s Data fully accomplished
 Employee’s Data fully accomplished
 Employer’s Data fully accomplished
 With wet ink signature
 Employee fully understands the undertaking
 SSS UMID ID
 PHIC ID (with date of birth)
 TIN ID
 Passport
 Driver’s License
 Barangay ID
 Police/NBI Clearance
 3 copies
 For updating of name or status
 With qualifying SSS contributions
 Notarized Certified True Copy
 Signature of Surgeon
 Name should be the same in Mat2 Form
 Notarized Certified True Copy
 Signature of Surgeon
 Name should be the same in Mat2 Form
 Notarized Certified True Copy

 Same name with SSS documents and IDs

 Employee’s Birth Certificate (Certified True
Copy)
 Marriage certificate, if married
 Death Certificate of spouse, if due to death of
previously reported spouse
 Certificate of Finality of Annulment/Nullity or
annotated Marriage Contract/Certificate, if due to
annulled or void marriage with previously reported
spouse
 Court Order on Declaration of Presumptive Death,
if previously reported spouse is presumed dead
 Decree of Divorce and Certificate of Naturalization
(granted before divorce) or its equivalent, if due to
divorce with previously reported spouse
 Certificate of Divorce (OCRG Form No. 102), if due
to divorce of Muslim member with previously
reported spouse
 I acknowledge that all submitted required
documents for completion of Mat 2 are
validated to be accurate and complete.
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Benefits POC’s Signature and Name/Date Signed
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EMPLOYEE’S COPY
ACKNOWLEDGEMENT

 I acknowledge that all submitted required

documents for completion of Mat 2 are
validated to be accurate and complete.

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Employee’s Signature and Name/Date Signed Benefits POC’s Signature and Name/Date Signed