igmeanel ‘SOCIAL SECURITY SYSTEM | | | | | | SELF-EMPLOYED DATA RECORD RS-1 oma SEINE TASS TAE EOF BRT RGEC RT aE bx EMESIS PETER WER Cua TISNGLE Juanes C]woower| RESIDENCE: OFeMALE OFFICE: OSTA CODE] PROFE_SSIOTEUSHES EAR PROFESSION” PROTESSIHUSHESS CODE ONTEGF [sete vsness srarreo fooweon evesAce AX TOENTIFICATION NOWBER SPOUSE YEARLY NET EARRINGS THONTALY RET EARRINGS FATHER TE [crICOREN h INoTrER WE [OTHER BENEFICIARIES [you do not Rave spouse, Geren and parents.) nae RELATIONSHIP hs lBRTERECENED: THEREBY CERTIFY THAT THE ABOVE STATEMENTS ARE] ‘TRUE AND CORRECT. SIGNATURE THOMBMARRS Leer RIGHT "PLEASE SEE WSTRUGTION AT THE BACK2 In registering as a self-employed, please submit the originallcertied true copy and the photocopy of the following documents if your have no SS number yet: ‘+ Primary documents (only ONE is required) = Baptismal certificate A ~ Birth certificate 5 - Driver's license - Passport Professional Regulation Commission Card ‘Seaman's Book * Secondary documents (in the absence of the primary documents, submit TWO of the following): Alien Certificate of Registration ‘ATM card with the cardholder's name ‘ATM card. and Certification from the bank, if without name ID card issued by professional ‘association recognized by PRC Life Insurance Policy Marriage Contract, ~ Bank Account Passbook Membership Card issued by ~ Birth/Baptismal Certificate of childfren private companies = Certificate from: NBI Clearance * Office of the Southern/Northem Overseas Worker Welfare Cultural Communities © Office of Muslim Affairs Cerificate of Licensure’ Qualification Documents! Seafarer’s ID & Record Book from Maritime Industry Authority Certificate of Naturalization from the Bureau of Immigration Company ID Company Representative Authorization Card issued by SSS. Credit Card Fisherman's Card issued by the Bureau of Fisheries & Aquatic Resources GSIS Card, GSIS Certificate of Membership ‘Administration Card Pag-ibig Member's Data Form Permit to Carry Firearms issued by the Firearms & Explosives Unit of PNP PHIC Member's Data Record Police Clearance Postal ID Card ‘School ID Seafarer's Registration Cerificate issued by the Philippine Overseas Employment Authority Senior Citizen Card Tax Identification Number Card ‘Temporary License issued the by - Health or Medical Card Land Transportation Office - ID Card issued by LGUs (eg. - Transcript of School Records Barangay/Municipa/City) Voter's Identification CardiAtfidavit