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This is SSS sickness notification form 2020. You may want to fill out this file because you had been sick for almost 4 days or you had been confined in the hospital.
Anyway, this SSS Sickness notification form 2020 can be directly downloaded form SSS official website. They have their guidelines their on how to fill this out and some other considerations before submitting this form.
You can other helpful files here.
By the way, are you planning to loan in SSS? You may be interested to know how much you can loan. You can use this calculator.