SSS Form R-5

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					                                                                                         Republic of the Philippines                SBR NO.          POST MARK/SBR          DATE      TELLER’S INITIAL

                                                                                        SOCIAL SECURITY SYSTEM
                              R-5                                                   CONTRIBUTIONS                                   AMOUNT
                              REV. 02-98                                           PAYMENT RETURN
                                                                                                                                    DATE
                                                                               (TO BE SUBMITTED IN QUADRUPLICATE)
                                                                                                                                              (THIS IS YOUR OFFICIAL RECEIPT WHEN VALIDATED)
EMPLOYER’S ID NUMBER                                                                  EMPLOYER’S REGISTERED NAME



ADDRESS                                                                                                                                                          POSTAL CODE
                        (NO. & STREET)                                                                                       (BARANGAY)



                                                                                                                             (CITY/PROVINCE)                     TEL. NO.
                        (TOWN/DISTRICT)


                                                                       APPLICABLE PERIOD                   SOCIAL SECURITY        EMPLOYEE COMPENSATION
                                                                                                            CONTRIBUTION                                                           TOTAL
           INSTRUCTIONS                                                 MONTH       YEAR                                              CONTRIBUTION

                                                                        JANUARY
1. CHECK THE BOX TO INDICATE THE TYPE OF
   PAYOR                                                               FEBRUARY
               REGULAR EMPLOYER                                          MARCH
               HOUSEHOLD EMPLOYER                                         APRIL
2.   INDICATE THE YEAR FOR WHICH PAYMENT                                     MAY
     IS APPLICABLE.
                                                                          JUNE
3.   REMIT YOUR EMPLOYEE’S/HOUSEHOLD
     HELPER’S MONTHLY CONTRIBUTIONS ON
                                                                           JULY
     OR BEFORE THE 5TH DAY OF THE
                                                                         AUGUST
     FOLLOWING MONTH TO AVOID THE 3%
     PENALTY PER MONTH FOR LATE PAYMENT.                              SEPTEMBER
4.   REMIT YOUR PAYMENT EITHER:                                         OCTOBER
     a) THROUGH SSS ACCREDITED BANK; OR                                NOVEMBER
     b) BY REGISTERED MAIL
                                                                       DECEMBER
5.   MAKE ALL CHECKS AND POSTAL
     MONEY ORDERS PAYABLE
                                                    PENALTY PAYMENT




     TO SSS
                                            UNDER
                                     ADD




      PENALTY REFERENCE NUMBER




6.    ATTACH YOUR EXTRA COPY
                                             PAYMENT




      OF THIS FORM AND SPECIAL
                                     LESS
                                               OVER




      BANK RECEIPT WHEN
      SUBMITTING THE
      CORRESPONDING
      CONTRIBUTION FORM R-3
      (CONTRIBUTION COLLECTION
      LIST) OR R-3 TAPE/ DISKETTE.                                      TOTAL REMITTANCE            P                             P                              P
7.    SUBMIT YOUR FORM R-3 WITHIN FIVE (5)
                                                                      FORM OF PAYMENT        AMOUNT                    TOTAL AMOUNT IN WORDS:
      DAYS AFTER THE APPLICABLE QUARTER                                      CASH   P______________________
      OR YOUR R-3 TAPE/DISKETTE ON OR
      BEFORE THE 10TH DAY OF THE MONTH                                       CHECK  P______________________
      FOLLOWING THE APPLICABLE MONTH
      TO THE NEAREST SSS OFFICE OR                                    BANK NAME : _____________________________        CERTIFIED CORRECT:
      THROUGH POSTAL SERVICES OFFICE.
                                                                      CHECK NO. : ______________________________
8.    INDICATE YOUR PENALTY REFERENCE
      NUMBER, IF ANY, FOR PAYMENT OF                                  DATE         : ______________________________
      PENALTIES.
                                                                      TOTAL               P______________________                                                SIGNATURE OVER PRINTED NAME

				
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Description: Downloadable Forms from SSS Philippines