How to write the unpaid social security certificate template of the company?

1. Employees who propose not to participate in social insurance must write a certificate in person and put their fingerprints on their signatures.

2. The certification format is as follows:

Prove:

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 (upper right grid)

Year and month (upper right box)