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Maternity Leave Form (Philippines)

Maternity Leave Form (Philippines)

MATERNITY LEAVE APPLICATION FORM

Republic Act 11210 (Expanded Maternity Leave Law of 2019) | SSS Circular No. 2019-012

Company / Employer: [Company Name]

Employer SSS Number: [Employer SSS Number]

EMPLOYEE INFORMATION

Employee Name: [Employee Name]

Employee ID: [Employee ID]

SSS Number: [SSS Number]

Department: [Department]

Position: [Position]

MATERNITY LEAVE DETAILS

Type of Delivery / Pregnancy Event: [Delivery Type]

Expected Date of Delivery (EDD): [Expected Delivery Date]

Actual Date of Delivery: [Actual Delivery Date]

Total Leave Days Entitled: [Leave Days Entitled]

Leave Start Date: [Leave Start Date]

Leave End Date: [Leave End Date]

Solo Parent (RA 8972): [Solo Parent]

SSS Maternity Notification Reference: [SSS Notification Reference]

Days Transferred to Father / Alternate Caregiver: [Transfer Days]

EMPLOYEE UNDERTAKING

I, [Employee Name], hereby apply for maternity leave under Republic Act 11210 (Expanded Maternity Leave Law of 2019). I certify that: (1) my SSS Maternity Notification has been filed with the Social Security System (SSS); (2) the information stated above is true and correct; (3) I understand that [Company Name] will advance the full maternity benefit and subsequently file for SSS reimbursement under SSS Circular No. 2019-012; and (4) if I am a certified solo parent under RA 8972, my valid DSWD Solo Parent Identification Card is attached to support the 15-day extension.

If I am transferring days to the child's father or an alternate caregiver, I confirm that a notarized Deed of Transfer of Maternity Leave Credits has been executed as required under Section 5 of the RA 11210 Implementing Rules and Regulations.

HR APPROVAL AND SSS REIMBURSEMENT RECORD

HR Officer: ___________________________ Date: _______________

SSS Reimbursement Claim Filed: _________ Amount: PHP _______________

Date of SSS Reimbursement Received: _______________

Employee

________________

Signature

HR Officer

________________

Signature

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a Maternity Leave Form (Philippines)?

A Maternity Leave Form in the Philippines records the details required for the process it supports, providing a clear written account that can be relied on.

The Maternity Leave Form triggers two parallel processes: the employee's internal HR leave application to the employer, and the SSS Maternity Notification filed directly with the Social Security System (SSS) at sss.gov.ph. Under Section 6 of the RA 11210 IRR, the female employee must notify her employer of the pregnancy and the expected date of delivery. The employer then advances the full maternity leave benefit equivalent to the employee's average daily salary credit under SSS rules and subsequently claims reimbursement from the SSS. For SSS members, the maternity benefit is computed based on the monthly salary credit (MSC) under the SSS contribution table, with a maximum daily maternity allowance of PHP 2,000 (effective 2023 under SSS Circular No. 2023-009).

RA 11210 extended maternity leave coverage to all female workers regardless of civil status or legitimacy of the child, including workers in the informal economy and self-employed SSS members. The law also allows the female worker to transfer up to seven days of the maternity leave to the child's father or an alternate caregiver — whether or not the father is married to the mother — under Section 5 of the IRR, documented through a notarized Deed of Transfer of Maternity Leave Credits. Government employees are covered under the GSIS (Government Service Insurance System) and the Civil Service Commission (CSC) Leave Policy rather than the SSS scheme.

The Maternity Leave Form must be distinguished from the Solo Parent Leave Form under RA 8972 (which covers the additional 15 days for solo mothers), the Paternity Leave Form under RA 8187 (for the child's father), and the Special Leave Benefit under RA 9710 (Magna Carta of Women), which provides two months of paid leave for gynecological surgery requiring hospitalization for at least one day.

The legal framework governing the Maternity Leave Form (Philippines) in Philippines draws on several key statutes and regulatory bodies. Under Philippine law, the Civil Code of the Philippines (Republic Act No. 386) governs contractual obligations. The Revised Corporation Code (Republic Act No. 11232) regulates corporate entities through the Securities and Exchange Commission (SEC). The Labor Code of the Philippines (Presidential Decree No. 442) and Department of Labor and Employment (DOLE) govern employment matters. The Data Privacy Act of 2012 (Republic Act No. 10173) and the National Privacy Commission (NPC) protect personal data. The Bureau of Internal Revenue (BIR) administers tax obligations under the National Internal Revenue Code. Parties executing a Maternity Leave Form (Philippines) in Philippines should confirm the document reflects current law, including any amendments enacted since the original drafting date. The Labor Code of the Philippines (PD 442) sets the foundational requirements.

When Do You Need a Maternity Leave Form (Philippines)?

A Maternity Leave Form is needed in the Philippines in the following situations.

A Maternity Leave Form is required when a female employee becomes pregnant and plans to avail of the 105-day paid maternity leave benefit under RA 11210. The form must be filed with the employer as early as possible, and the SSS Maternity Notification must be submitted to the SSS at least 60 days before the expected date of delivery to confirm timely SSS reimbursement to the employer.

A Maternity Leave Form is needed when a female employee suffers a miscarriage or undergoes emergency termination of pregnancy, entitling her to 60 days of paid maternity leave under Section 3 of RA 11210. In this case, the form documents the medical event and supports the SSS maternity benefit claim for miscarriage under SSS Circular No. 2019-012.

A Maternity Leave Form is required when a solo mother certified under RA 8972 and holding a valid Solo Parent Identification Card from the DSWD applies for the additional 15-day maternity leave extension, bringing her total entitlement to 120 days. The solo parent certification and ID must be attached to the form.

A Maternity Leave Form is needed when the female employee wishes to transfer up to seven days of her maternity leave credits to the child's father or an alternate caregiver under Section 5 of the RA 11210 IRR, requiring a notarized Deed of Transfer of Maternity Leave Credits and a separate leave application by the transferee.

A Maternity Leave Form is required when an employer needs to document the maternity leave period for payroll purposes, SSS reimbursement claim preparation, and DOLE compliance inspections under Department Order No. 183-17.

Parties in Philippines should prepare a Maternity Leave Form (Philippines) proactively rather than waiting for a dispute to arise. Courts interpret agreements based on the written terms rather than oral representations. Under Philippine law, the Civil Code of the Philippines (Republic Act No. 386) governs contractual obligations. The Revised Corporation Code (Republic Act No. 11232) regulates corporate entities through the Securities and Exchange Commission (SEC). The Labor Code of the Philippines (Presidential Decree No. 442) and Department of Labor and Employment (DOLE) govern employment matters. The Data Privacy Act of 2012 (Republic Act No. 10173) and the National Privacy Commission (NPC) protect personal data. The Bureau of Internal Revenue (BIR) administers tax obligations under the National Internal Revenue Code. Where the transaction involves regulated activities, prior approval from the relevant authority may be required before execution.

What to Include in Your Maternity Leave Form (Philippines)

A valid Philippines Maternity Leave Form contains the following essential elements.

Employee and Employer Information: Full name of the female employee, employee ID, department, position, company name, and employer SSS number. The employer's SSS registration number is required for the SSS reimbursement claim under SSS Circular No. 2019-012.

SSS Membership Details: The employee's SSS number, which links the maternity leave form to her SSS contribution record. The SSS maternity benefit is available only to SSS members with at least three monthly contributions in the 12-month period immediately preceding the semester of the childbirth, miscarriage, or emergency termination of pregnancy.

Pregnancy and Delivery Information: Expected date of delivery (EDD) as certified by a licensed obstetrician-gynecologist (OB-GYN) or attending physician with PRC license number, type of expected delivery (normal spontaneous delivery or caesarean section), and actual date of delivery or miscarriage upon completion of the event.

Leave Period: Start and end dates of the maternity leave in MM/DD/YYYY format, total number of calendar days (105 days for live birth, 60 days for miscarriage), and whether the 60 days pre-delivery option is being used (employees may allocate up to 60 days of the 105-day leave before the expected delivery date).

Solo Parent Status: Declaration of whether the employee is a certified solo parent under RA 8972 with a valid DSWD Solo Parent ID, entitling her to the additional 15-day extension to 120 days total.

Transfer of Credits: If up to seven days are being transferred to the child's father or alternate caregiver, reference to the notarized Deed of Transfer of Maternity Leave Credits.

SSS Notification Reference: The SSS Maternity Notification reference number confirming the SSS has been notified at least 60 days before delivery, as required for employer reimbursement eligibility.

Additional compliance elements for a Maternity Leave Form (Philippines) used in Philippines include: Under Philippine law, the Civil Code of the Philippines (Republic Act No. 386) governs contractual obligations. The Revised Corporation Code (Republic Act No. 11232) regulates corporate entities through the Securities and Exchange Commission (SEC). The Labor Code of the Philippines (Presidential Decree No. 442) and Department of Labor and Employment (DOLE) govern employment matters. The Data Privacy Act of 2012 (Republic Act No. 10173) and the National Privacy Commission (NPC) protect personal data. The Bureau of Internal Revenue (BIR) administers tax obligations under the National Internal Revenue Code. Forms-legal.com provides this template as a starting point for Philippines-compliant documentation.

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Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Maternity Leave Form (Philippines) (Philippines) [Legal document template]. Forms Legal. https://forms-legal.com/philippines/employment/hr-forms/maternity-leave-form-philippines

MLA

"Maternity Leave Form (Philippines) (Philippines)." Forms Legal, 2026, https://forms-legal.com/philippines/employment/hr-forms/maternity-leave-form-philippines.

BibTeX
@misc{formslegal-maternity-leave-form-philippines,
  author       = {{Forms Legal}},
  title        = {Maternity Leave Form (Philippines) (Philippines)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/philippines/employment/hr-forms/maternity-leave-form-philippines}},
  note         = {Free legal document template. Based on Labor Code of the Philippines (PD 442)}
}

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Frequently Asked Questions

Based on Labor Code of the Philippines (PD 442) — Template last modified June 2026

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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