E6 Form Sample PDF Details

Navigating the process of securing a Social Security Card in the Philippines can seem daunting, but understanding the E6 Sample Form is a great place to start. This form is essential for anyone looking to apply for a Social Security Card, whether it's for the first time or to replace a lost, damaged, or outdated card. Detailed instructions on the form guide applicants through filling it out, including specifying information in capital letters using black ink, which is crucial for clarity. The form is divided into various sections, capturing an array of information from personal details and demographic data to specifics regarding the purpose of the application, like initial enrollment or card replacement. It’s also designed with privacy and security in mind, as it collects sensitive information that forms part of the Unified Multi-Purpose ID (UMID) System, ensuring confidentiality and proper use under the executive orders that govern it. Additionally, the form outlines the necessary supporting documents and the process for submission, payment of the required fee, and how to accurately indicate choices for the form's purposes. Understanding the E6 Sample Form is a key step for applicants in navigating their social security needs efficiently and with confidence.

QuestionAnswer
Form NameE6 Form Sample
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessss e6 form 2021, sss form e6, sss form e 6, sss id online application

Form Preview Example

 

Republic of the Philippines

E-6

SOCIAL SECURITY SYSTEM

APPLICATION FOR SOCIAL SECURITY CARD

COV- (02-2011)

Please read the instructions/reminders 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 APPLICANT

SS NUMBER/COMMON REFERENCE NO.

0 0

NAME (LAST NAME)

(SUFFIX)

(FIRST NAME)

(MIDDLE NAME)

A. FACTS OF BIRTH

SEX

 

DATE OF BIRTH (MM/DD/YYYY)

PLACE OF BIRTH (CITY/MUNICIPALITY)

(PROVINCE/STATE)

(COUNTRY)

Male

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF FATHER

(FIRST NAME)

(MIDDLE NAME)

(LAST NAME)

(SUFFIX)

 

 

 

 

 

 

 

 

 

 

 

 

 

MOTHER'S

 

(FIRST NAME)

(MIDDLE NAME)

(LAST NAME)

(SUFFIX)

MAIDEN NAME

 

 

 

 

 

 

 

 

 

 

 

B. CURRENT DEMOGRAPHIC DATA

ADDRESS (RM/FLR/UNIT NO. & BLDG. NAME)

(HOUSE/ LOT & BLK NO.)

(STREET NAME)

(BARANGAY/DISTRICT/LOCALITY)

(SUBDIVISION)

(CITY/MUNICIPALITY)

(PROVINCE)

(COUNTRY)

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MARITAL STATUS

 

 

 

 

TIN

Single/Unmarried

Married

Widowed/Widower

Legally Separated

Divorced/Annulled

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEIGHT (CENTIMETERS)

WEIGHT (KILOS)

DISTINGUISHING FACIAL FEATURES

TELEPH0NE NUMBER

MOBILE NUMBER

E-MAIL ADDRESS (IF ANY)

C. DECEASED/PENSIONER MEMBER DATA

If you are a surviving spouse/guardian/dependent of deceased/pensioner member, indicate his/her SS number and full name below.

SS NUMBER/COMMON REFERENCE NO.

0

0

 

 

NAME OF MEMBER(LAST NAME)

(FIRST NAME)

(MIDDLE NAME)

D. PURPOSE

INITIAL ENROLLMENT

 

 

 

CARD REPLACEMENT

 

 

 

Amendment of Name

Replacement of Lost Card

Amendment of Authenticating Finger

Others

Amendment of Facts of Birth

Amendment of Demographic Data

Replacement of Damaged Card

 

E. APPLICANT'S CERTIFICATION

I declare that I am fully aware that the above data shall be used for the Unified Multi-Purpose ID (UMID) System and that it shall form part of the CRN Registry. I trust that the above data shall remain confidential hence, I give my consent that the same data be secured and accessed for subsequent validation, verification, and other purposes consistent with the objectives of the UMID System under Executive Order Nos. 420 and 700. I further affirm that all statements/data, which appear in this form and made by me are true and complete to the best of my knowledge and belief.

 

SIGNATURE OVER PRINTED NAME

 

DATE

 

 

 

 

 

 

 

 

 

RIGHT THUMB

RIGHT INDEX

 

 

 

(Affix your fingerpints only upon instruction of SSS personnel.)

WITNESS TO FINGERPRINTING, IF APPLICANT CANNOT SIGN:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OVER PRINTED NAME

 

DESIGNATION

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

PART II - TO BE FILLED OUT BY SSS

 

 

IDENTIFICATION/DOCUMENT(S) PRESENTED

 

REMARKS

 

 

 

 

 

 

 

 

 

 

 

VERIFIED AND RECEIVED BY:

 

RECEIVING BRANCH

DATA CAPTURED BY:

 

 

SIGNATURE OVER PRINTED NAME

DATE

TIME

SIGNATURE OVER PRINTED NAME

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERFORATE HERE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Republic of the Philippines

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY SYSTEM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICATION FOR SOCIAL SECURITY CARD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COV- (02-2011)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACKNOWLEDGMENT SLIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SS NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

NAME (LAST NAME)

(FIRST NAME)

 

 

 

(MIDDLE NAME)

 

 

 

 

 

 

0 0

VERIFIED & RECEIVED BY:

 

 

 

SIGNATURE OVER PRINTD NAME

DATE

TIME

BRANCH

DATA CAPTURED BY:

 

SIGNATURE OVER PRINTED NAME

DATE

INSTRUCTIONS

1. Fill out this form in one (1) copy and submit to the SSS branch office nearest the place of your work (if you are employed) or your residence (if not employed).

2.Submit this form together with the supporting documents/IDs; and

If replacement,

-Validated Miscellaneous Payment Return (SS Form R-6) or SS Form R-6 with Special Bank Receipt; and

-Affidavit of Loss, if lost; or the old SS card if due to other reason.

3.Pay the required fee using the Miscellaneous Payment Return (SS Form R-6) to any SSS branch with tellering facilities, SSS-accredited banks or SSS-authorized payment centers for replacement of card.

4.Use "x" to tick/pick applicable box to indicate choice.

5.Indicate "suffix", if any, which refers to name extension such as Jr., II, III, 2nd, etc.

6.Indicate maiden name for married female member on the appropriate row.

7.Indicate permanent address rather than the temporary mailing address. For example, if with permanent residence in the province but working or staying in Manila during weekdays, indicate the provincial address instead of the Manila address.

8.Write the "Height" in centimeters and "Weight" in kilos. (To convert: 1 ft = 30.38cm; 1 in = 2.54cm and 1 lb = 0.4536 kg).

9.Limit the distinguishing features to those that can be found on the face such as "mole under the right eye" and "mole or birth mark on the left cheek/forehead".

10.Mark only one (1) under "Purpose" as follows:

-Select "Initial Enrollment", if never been issued Common Reference Number (CRN)/Unified Multi-Purpose Identification (UMID) card; or

-Select "Replacement" and the corresponding reason.

11.Affix your fingerprints only upon the instruction of SSS personnel.

12.Present your acknowledgement slip together with the supporting documents/IDs and the validated SS Form R-6 or SS Form R-6 with SBR, if any, when verifying the status of your card.

REMINDER

1.This form can also be downloaded or filled out electronically thru the SSS website (www.sss.gov.ph).

How to Edit E6 Form Sample Online for Free

Using the online PDF tool by FormsPal, you may fill out or modify e 6 form sss here and now. Our tool is continually evolving to deliver the best user experience possible, and that's due to our dedication to continual enhancement and listening closely to customer feedback. To get the process started, consider these basic steps:

Step 1: Firstly, open the pdf tool by clicking the "Get Form Button" above on this site.

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When it comes to blanks of this particular PDF, here is what you need to do:

1. Fill out your e 6 form sss with a number of necessary blank fields. Gather all the required information and ensure nothing is overlooked!

Filling in segment 1 in ss form e 6 acknowledgment stub

2. After finishing this section, go on to the subsequent step and fill in the necessary particulars in these blank fields - If you are a surviving, NAME OF MEMBER, LAST NAME, FIRST NAME, MIDDLE NAME, INITIAL ENROLLMENT, CARD REPLACEMENT, D PURPOSE, Amendment of Name, Replacement of Lost Card, Amendment of Authenticating Finger, Others, Amendment of Facts of Birth, Amendment of Demographic Data, and Replacement of Damaged Card.

Part number 2 in filling out ss form e 6 acknowledgment stub

People generally get some points wrong while filling out Replacement of Damaged Card in this part. You should definitely read twice whatever you enter here.

3. Through this part, examine VERIFIED AND RECEIVED BY, RECEIVING BRANCH, DATA CAPTURED BY, SIGNATURE OVER PRINTED NAME, DATE, TIME, SIGNATURE OVER PRINTED NAME, DATE, PERFORATE HERE, Republic of the Philippines, SOCIAL SECURITY SYSTEM, APPLICATION FOR SOCIAL SECURITY, ACKNOWLEDGMENT SLIP, NAME LAST NAME, and FIRST NAME. All of these will need to be taken care of with greatest precision.

Step no. 3 for completing ss form e 6 acknowledgment stub

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