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Obstetrical History indicating number of pregnancies and Hydatidiform Mole (H-mole), certified by attending doctor, with PRC License No., printed name and signature 5.
Pregnancy Test result before and after miscarriage or Ultrasound Report before and after miscarriage 6.
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Pregnancy Ultrasound Reports or Pregnancy Test results before and after D&C 8.
SSS might require additional documents if basic documents are defective or not valid FOR SEPARATED, PREVIOUSLY EMPLOYED, SELF-EMPLOYED, or VOLUNTARY MEMBERS: If your miscarriage occurred while employed or within 6 months of your date of separation from your company, submit these additional documents: .
Certificate of Separation from Employment, with effective date of separation .
Certification of Non-Advancement of Maternity Benefit (certification from employer that no advance payment was granted to you) .
Maternity Benefit Application (if Voluntary, Self-employed, OFW or Separated) Maternity Benefit Reimbursement Application (if Employed) 2.