Republic of the Philippines PAYOR's COPY
SOCIAL SECURITY SYSTEM
CONTRIBUTIONS
ON-012759 (11-2016) PAYMENT FORM
(aS 16 YOUR OFFAL RECET WHEN VALOATED)
JPLEASE READ THE INSTRUCTIONS AT THE BACK BEFORE FILLING OU
[is FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE|
‘TO.BE FILLED OUT BY EMPLOYER AND INDIVIDUAL PAYOR
DORESS TRUTRTUNT NG A BIDG WANE] TROURELGT EIR ROT STREET RMT [Saou SONG RTITOCATT
TERRE TOME TAR TDENTIFIGATION NUMBER ray
TEPHONE NUMBER na coorra no) — J MOBICEIGELLPHONE NOMEER A [WEBSITE penosenass nore
"APPLICABLE PERIOD. ‘SS CONTRIBUTION EC CONTRIBUTION TOTAL
(70 8 FLED OUT BY EUPLOWER AMOWOUAL ToBeRUuED our ey roserusoourey
MONTH YEAR Paro Buyer Sa ewan ONL
lanuary =
February
‘March
‘Api
May
FOTAL AMOUNT OF PAYMENT.
FOR OF PAYMENT
cash 2
Gi Postal Money Order
Geneck
‘Check Number
Check Date
‘Bank & Branch Name
TOTAL AMOUNT PAID PRINTED AE SIGRATUREINSTRUCTIONS
+1. Always indicate "NIA" or "Not Applicable’ i the required datas not applicable.
2. Pay trough any of the following:
‘SSS Branch wih Tellerng Facies
Accredited Banks
Post Offce
Bayad Centers
SM Business Centers
5. Make al checks and postal money orders payable to SSS. Fil ou propery the check details inthe “Form of Payment” porton
ForEmployer
1. Accomplish appropriate boxes 2s folows
‘a. For business employer
= employer number, business name, business address and 12-digit business TIN as registered with the SSS
». Forhousehold employer
= employer number, household employer name, home address and 8-cigit personal TIN, if any as registered wih the SSS
2. As business/houschold employer. pay your contrbutions folowing the payment deadine to avoid the three percent (9%) penalty
per month or late payment
the 10° digit of the Payment Deadline
‘S.diot Emolover (ER i (folowing the applicable month
tore 10" day of the month
Sard 15% ay of the month
Ser8 7207 gay of the month
Tord 25" day ofthe month
ord) Last day ofthe month
\n case the payment deadline fals on a Saturday, Sunday or holiday, payment may be made on the next working day
3. Submit immediately a copy of validated "Contributions Payment Form" or "Contributions Payment Form" with Special Bank
Receipt (SBR) together with the corresponding “Contributions Collection List" or “Contibuions Collection List” in electronic
‘media device to the nearest SSS branch
For Individual Payor (Sel Empioved, Volu Ni
4. Acoomplish appropriate boxes as follows:
= 8S number
~ Full name as registered with the SSS
= Common Reference Number (CRN), any
= Sig personal TIN, itany
2. Pay your contributions folowing the payment deadline o avoid application of payments prospectively.
0, Farmerisherman and Overseas Filipino Worker
a r tary, Non- Working Spouse, Farmer/Fisherman
Ifthe 10" iat of the Payment Deadine
‘SS number ends i {folowing the applicable month or quarter)
Tor? 10" day of the month
Bor4 45" day of the month
Sor6 20" day ofthe month
Tor8 25" day of the month
9or0 Last day of the month
. For Overseas Fllpine Worker (OF)
e+ Gararbasions br Janwary bs Decesrbar of & giver your recy bs pal anya wat the sures your
+ Contibuions for October to December of a given year may also be paid uni 31 January ofthe succeeding year.
In case the payment deadline fas on @ Saturday, Sunday or holiday, payment may be made on the next working day. Otherwise,
late contribution payments shall be applied prospectively.
43, Fillout the following portions:
4. "8S" column only ofthe “PAYMENT DETAILS” portion (need not fil out the “Total” column).
‘Declaration of Earnings of Individual Payor” porton if you want to change your monthly salary credit (MSC) to more than
‘two (2) salary brackets higher or lower than your present MSC,
However, the following shall be observed:
+ For OFW, the minimum MSC shal be P5,000.00. Hence, any change lower than the minimum MSC shall not be allowed.
+ Whore the present MSC is move than 10,000.00 and the age of the member i 55 years old of older, the allowed
increase is only one 1) salary bracket regardiess of whether the Supporting documents are submited or ot.
REMINDERS
1 The total contributions paid by the Employer inthis payment form includes the Social Security contributions shared by both the
‘employer and employee plus the EC contributions shouldered solely by the employer, in accordance with the SSS monthly
contribution schedule,
2. You may also visit the SSS Website at wwmwsss.g0v.ph for other payment facie.
3. Keep all your validated payment forms for future reference.WA
|Con-o1279 (11-2016)
IBLACK INK ONLY,
Ci Business
IEWPLOYER NUMBER
JEMPLOVER NAN
[ADDRESS
TOBE FILLED OUT BY EMPLOYER,
TREAT RO EBS WaT
Republic of the Philippines
SOCIAL SECURITY SYSTEM
CONTRIBUTIONS
PAYMENT FORM
JPLEASE READ THE INSTRUCTIONS AT THE BACK BEFORE FILLING OUT]
[THis FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE|
1D Househois
"TO.BE FILLED OUT BY EMPLOYER AND INDIVIDUAL PAYOR
(SES
TERRE
RORY
[ar CODE
[TAX IDENTIFICATION NOMBER pa
hao TNOMBER orca Sane Roy
"APPLICABLE PERIOD
YEAR] TOserDoUTareumoTER
‘SS CONTRIBUTION
{OBILETCELLPHONE NUMBER
"EC CONTRIBUTION
TToaeRLuED out ey
[WEBSITE penoienareconioey
TOTAL
e
February
March
‘check Number
‘Check Date
"ANOUNT PAID IN FIGURES
e
‘Bank & Branch Name
TOTAL AMOUNT PAID
PRINTED NAME
‘SIGRATUREINSTRUCTIONS,
1. Always indicate "NIA" or "Not Applicable’ f the required data isnot applicable.
2, Pay through ary of the following:
‘SSS Branch with Tellering Facies
Accredited Banks
Post Office.
Bayad Centers
‘SM Business Centers
3. Make all checks and postal money orders payable to SSS. Fill out property the check detalsn the "Form of Payment” portion
For Employer
1. ‘Accomplish appropriate boxes as follows:
‘a. For business employer
= employer number, business name, business address and 12.. For il (OEW
* Contributions for January to December of a given year may be pad anytime within the same year.
+ Contributions for October to December of a given yeat may also be paid unt 31 January ofthe succeeding year.
In case the payment deadline fas on 2 Saturday, Sunday or holiday. payment may be made on the next working day. Otherwise,
late contribution payments shall be applied prospectively.
3, Fil out the following portions:
'8. "SS" column only ofthe ‘PAYMENT DETAILS" portion (need nat fil ut the “Tota” column)
. "Declaration of Earnings of Individual Payor” portion if you want to change your monthly salary erect (MSC) to more than
two (2) salary brackets higher or lower than your present MSC.
However, the following hall be observed
+ For OFW, the minimum MSC shall be P5,000.00. Hence, any change lower than the minimum MSC shal not be allowed.
* Where the present MSC is more than 10,000.00 and the age of the member is 5S years old or older, the alowed
increase is only one (1) salary bracket regardiess of whether the supporting documents are submitted or not
{EMINDERS
1. The total contributions paid by the Employer in this payment form includes the Social Security cntibutions shared by both the
femployer and employee plus the EC contributions shouldered solely by the employer, in accordance wih the SS$ monthly
contribution schedule.
2. You may also visit the SSS Website at www. ses.g0x.9h fr ther payment facts,
3. Keep all your validated payment forms for future reference.