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 SIGRATUREINSTRUCTIONS +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 ‘SIGRATUREINSTRUCTIONS, 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.