How to write the unpaid social security statement?

If the employee proposes not to participate in social insurance, the employee must personally write a certificate and put his handprint on the signature. The certificate format is as follows:

certificate

I am xxx, male/female, with ID number, and I worked in xxxxXX Company on XX, XX. For personal reasons, I don't want xxxxxx company to buy five insurances for me, such as old-age insurance, unemployment insurance, maternity insurance, work-related injury insurance and medical insurance. I am willing to take all responsibilities for this.

Hereby certify!

xxx

date month year