REMITTANCE ADVICE: FORM P4A

NATIONAL SOCIAL SECURITY AUTHORITY

Industry Code …… Wcif rate

SSR No...……
Contribution Month……
Employer's Name………
Address……………
Tel….
Cash/ RTGS/ Cheque Number….

CONTRIBUTION PAYABLE FOR POBS APWCS

Number of Employees

Total Insurable Earnings

Current Contributions (see notes on the instruction page)

Arrears

Pre-payments

Surcharge

Total Payment
GRAND TOTALS

In terms of SI 393 as amended, the employer must remit contributions by the 10th day of the month following deduction, whether or not
an invoice has been received.
**Failure to pay contributions by the 10th of the month will result in surcharges and interest being levied on your account.**in the event
of WCIF payment not being made by the due date, you are considered uninsured.

In case of queries, please contact the Collections Enquiry Ofiice at your nearest Regional Office

DECLARATION I declare that the above information is a true reflection of the contribution due in respect of all insured employees for the month .

Signed …… Date…..

Name …… Position Held…..

Company Stamp