Downloadable application form for Penalty Condonation Program

1. Republic of the Philippines
SOCIAL SECURITY SYSTEM
APPLICATION FOR MEMBER LOAN PENALTY
(07-2010)
CONDONATION PROGRAM FOR EMPLOYERS
Please read the terms & conditions at the back before accomplishing this form. Print all information in capital letters and use black ink only.
PART I - TO BE FILLED OUT BY THE EMPLOYER
MODE OF AVAILMENT
FULL PAYMENT INSTALLMENT
EMPLOYER NUMBER NAME OF EMPLOYER/REGISTERED BUSINESS NAME
ADDRESS (NO. & STREET) (BARANGAY) (TOWN/DISTRICT) (CITY/PROVINCE) POSTAL CODE
TELEPHONE/MOBILE NUMBER EMAIL ADDRESS (If any) TIN
EMPLOYER'S CERTIFICATION
I certify that the information provided in this form regarding employer's details are true and correct. Further, I agree
to the terms and conditions of the program as enumerated at the back of this form.
SIGNATURE OVER PRINTED NAME OF OFFICIAL DESIGNATION DATE
EMPLOYER/AUTHORIZED REPRESENTATIVE
PART II - TO BE FILLED OUT BY SSS
DOCUMENT(S) SUBMITTED
Loan Delinquency Report Installment Proposal Secretary's Certificate for Corporation
Notarized Promissory Note Other Documents:
MEMBER SERVICES SECTION INSPECTORATE SECTION APPROVED BY
RECEIVED BY PROCESSED BY
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE BRANCH HEAD DATE
SIGNATURE OVER PRINTED NAME
OPERATIONS ACCOUNTING SECTION
ENCODED BY REVIEWED BY
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Perforate Here
APPLICATION FOR MEMBER LOAN
PENALTY CONDONATION PROGRAM FOR EMPLOYERS
ACKNOWLEDGEMENT STUB
EMPLOYER NUMBER NAME OF EMPLOYER/REGISTERED BUSINESS NAME
RECEIVED BY RECEIVING BRANCH
SIGNATURE OVER PRINTED NAME DESIGNATION DATE
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Note: If with unposted payment/s, please submit copy/ies of proof of payment/s.
ith t d t/ l b it /i f f f t/

2. TERMS AND CONDITIONS
WHO CAN AVAIL OF THE PROGRAM?
1. Employers who are delinquent in the remittance of their employees' loan amortizations (salary, calamity, emergency, educational,
special educational loan for Y2K conversion, stock investment and privatization fund), including the following:
1.1 Those with pending or approved installment proposal on loans;
1.2 Those with pending or approved applications to settle loan obligations through Dacion en Pago of the SSS; and
1.3 Those with pending cases before the SSC, Courts or the Office of the Prosecutor.
2. Employers of employees with delinquent loans granted under the current or previous employer or whose loans were granted as self-
employed (SE)/voluntary -paying member (VM).
WHAT IS CONDONED UNDER THE PROGRAM?
The program shall condone only penalties on unremitted or delinquent loan amortizations due on or before 01 April 2010. The loan amount
is composed of the principal and interest.
WHAT IS THE AVAILMENT PERIOD OF THE PROGRAM?
Availment period of the Program is six (6) months from 03 January 2011 to 30 June 2011.
WHAT ARE THE MODES OF PAYMENT UNDER THE PROGRAM?
The employer may settle their delinquent accounts either in:
1. Full payment (cash or check); or
2. Installment payment through post-dated checks
WHAT ARE THE DOCUMENTARY REQUIREMENTS FOR SUBMISSION?
Submit the accomplished Application for Member Loan Penalty Condonation Program for Employers together with the documents listed
under f ll or i t ll
d full installment payment:
t t
Full Payment
- Loan delinquency report signed by the employer in the "conforme" portion
Installment Payment
- Loan delinquency report signed by the employer in the "conforme" portion
- Agreed installment payment computation
- Installment proposal signed by the authorized signatory of the company
- Notarized promissory note signed by the authorized signatory of the company
- Secretary’s Certificate, in case the corporation is operational or equivalent instrument in case of an unincorporated employer, authorizing
such officer to sign the proposal in behalf of the employer
WHAT ARE THE EFFECTS OF FAILURE TO PAY IN FULL OR DEFAULT IN INSTALLMENT?
In case the employer fails to pay in full the loan amortizations or defaults in the payment of any installment within the period provided in the
approved installment proposal, the penalties shall be re-imposed on the remaining balance and shall continue to accrue until the delinquent
account is paid in full.
WARNING
ANY PERSON WHO MAKES ANY FALSE STATEMENT IN THIS APPLICATION OR SUBMITS ANY FALSIFIED
DOCUMENT IN CONNECTION WITH ANY CLAIM FOR ANY BENEFIT PAYABLE UNDER THE SOCIAL SECURITY
ACT LAW (R.A. 1161, AS AMENDED) OR APPLICATION FOR LOAN WITH THE SSS SHALL BE LIABLE
CRIMINALLY UNDER SECTION 28 OF R.A. 8282 OR UNDER PERTINENT PROVISION OF THE REVISED PENAL
CODE OF THE PHILIPPINES.