115122, 1144 PM RTP, N PAYMENT REFERENCE NUMBER (PRN) Lean typaitoan Date: SALARY 12019 | | cu MI Ill tat Amun Ou: P 7080 evan One osn022 6220020465476 Please pay on or before the de date at any SSS accractes colecting parner or SSS Branch Office wit Teleng Facily. A penalty of 1% por monty, pursuant to Annex Al Grewia No, 20%9-0%4, shall be posed on loan amrtzation net paid wisn the preserbed echedule, ‘Te SSS reserves he fght to dotermin and collect tha true and corect loan amotizationdus'c the SSS ins othor Lnremitedtunderpis oan remitances during or before the period bles. Also, SSS shal conduct further verfeation and ‘assessment onthe deta ofthe submited Loan Collecton List, applicable, and shal cole! ary amount due, f ary Foringuires, eal us at pmnelpline@se8.g0.ph and member relalons@see.govph. You may call the SSS Hotlne at 1455, ‘leace print tis form in to (2)capes (1 -Payors Copy and ~ SSS’ copy or present your PRN and aocomplih Payment Sip if payment willbe made a1 an SSS Branch Ofice wih Tolling Foeiy, This is a systim-generated Statement of Account wth Payment Reference Number hitps members. govpmembersiappmanagerportalhome?_nfpb=true&_nfx=false8_pagelabel=P1180023225159902344777Hwlp_P116002522... 1/1