SSS FORM ML-1(Rev.

03/98)
(This is your official receipt when validated)
Republic of the Philippines
SOCIAL SECURITY SYSTEM
MONTHLY -SALARY/CALAMITY/EDUCATIONAL/
MONTHLY SBR NO. Postmark/S & R Date Teller’s Initials
EMERGENCY/STOCK INVESTMENT LOAN
P A Y M E N T R E T U R N AMOUNT
(To be submitted in 3 copies)
DATE

EMPLOYER ID NUMBER TR. NO.-M.N.

EMPLOYEE SS NUMBER

06-2250181-9
ENTER TYPE OF P AYMENT BEL
PA BELOOW (Salary/Calamity/
EMPLOYER’S REGISTERED NAME & ADDRESS
Educational/Emergency/Stock Investment Loan):
PAYMENT TYPE APPLICABLE MONTH

Salary Loan October 2010

(FOR SSS USE ONLY- Do not alter or change amount printed

in this box) Enter total amount collected
per collection list
P 1,000.00
Amount due per collection list P
Add: Penalty
Prior periods P
Penalty

Prior periods Less: Over Payment P

over payment

Prior periods Add: Under Payment P

under payment
Please pay on or before Total Amount 1,000.00
Remitted P
NET DUE P Total amount remitted in words

One thousand Pesos Only

INSTRUCTIONS

1. Pay your monthly amortization on the following schedule: PAYMENT MADE IN: (All checks & postal money orders must be
Employer - on or before the 5th calendar day
following the applicable month.
made payable to Social Security System)
Self-Employed/Voluntary Member - on or before the last working day of the
applicable month. Check/PMO: Bank _____________ Check No.________ Date ___________
2. Always indicate your ID or SS number along with your name and address.
3. Use this form exclusively for your SALARY/CALAMITY/EDUCATIONAL/ Cash: P ____________________________
EMERGENCY/STOCK INVESTMENT LOAN payments.
4. Always support this form with the SSS official pre-printed collection list to ensure
proper posting of payments. If the employers do not receive the list, please notify the CERTIFIED CORRECT: __________________________________________
respective SSS office. (SIGNATURE OVER PRINTED NAME)
5. Leave employer ID No. blank if individual payment.

Official Designation: ____________________________________________

Internet Edition (1/2003)