Documente Academic
Documente Profesional
Documente Cultură
R-5
CON-
(10-2008)
(03-2013)
EMPLOYER CONTRIBUTIONS
PAYMENT RETURN
(THIS IS YOUR OFFICIAL RECEIPT WHEN VALIDATED)
PLEASE READ THE INSTRUCTIONS AT THE BACK BEFORE FILLING OUT THIS FORM.
PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY.
EMPLOYER NUMBER
EMPLOYER NAME
7 -
2 1 0 7 8
5 -
ADDRESS
(STREETNAME)
(BARANGAY/DISTRICT/LOCALITY)
GORRICETA AVENUE
(SUBDIVISION)
(CITY/MUNICIPALITY)
(PROVINCE)
PAVIA
TELEPHONE NO. (AREA CODE+TEL. NO.)
0 3 3
3 2
0 5
APPLICABLE PERIOD
MONTH
YEAR
JANUARY
2015
5 0 01
4 2
E-MAIL ADDRESS
3 2
2 0 1
WEBSITE
6 1
SOCIAL SECURITY
CONTRIBUTION
ILOILO
MOBILE/CELLPHONE NO.
BALABAG
ZIP CODE
8,965.00
TYPE OF PAYOR
EMPLOYEES'
COMPENSATION
CONTRIBUTION
110.00
TOTAL
9,075.00
FEBRUARY
BUSINESS EMPLOYER
HOUSEHOLD EMPLOYER
FORM OF PAYMENT
CASH
MARCH
CHECK
APRIL
MAY
CHECK NUMBER
JUNE
CHECK DATE
JULY
BANK/BRANCH NAME
9, 075.00
63885393
2/12/2015
ALLIED BANK
AUGUST
SEPTEMBER
9, 075.00
OCTOBER
NOVEMBER
DECEMBER
8,965.00
110.00
9,075.00
PENALTY
CERTIFIED CORRECT
INTEREST
ADD
UNDER
PAYMENT
SUB-TOTAL
SUB-TOTAL
CON(10-2008)
PRINTED NAME
GENERAL MANAGER
9, 075.00
POSITION TITLE
SIGNATURE
2/12/2015
DATE
INSTRUCTIONS
1. Fill out this form in three (3) copies and accomplish appropriate boxes as follows:
a. For business employer
- employer number, business name, business address and business TIN as registered with the SSS in
"Employer Registration" (Form R-1)
b. For household employer
- employer number, household employer name, home address and personal TIN as registered with the
SSS in "Employer Registration" (Form R-1)
2. Place a checkmark on the applicable box.
3. Always indicate "N/A" or "Not Applicable", if the required data is not applicable.
4. Remit your contributions following the payment deadlines below for both the business employer and household
employer:
If the 10th digit of the
13-digit Employer (ER) number ends in:
1 or 2
3 or 4
5 or 6
7 or 8
9 or 0
Payment Deadline
(following the applicable month)
10th day of the month
15th day of the month
20th day of the month
25th day of the month
Last day of the month
In case the payment deadline falls on a Saturday, Sunday or holiday, payment may be made on the next working day.
5. Remit the monthly contributions of your employees/household employees through any of the following:
a. SSS branch office with tellering facility
b. accredited banks
c. authorized payment centers
6. Make all checks and postal money orders payable to SSS. Fill out properly the check details in the "Form of
Payment" portion.
7. Submit a copy of validated "Employer Contributions Payment Return" (Form R-5) or "Employer Contributions
Payment Return" (Form R-5) with Special Bank Receipt (SBR) together with the corresponding "Contribution
Collection List" (Form R-3) within ten (10) days after the applicable quarter or "Contribution Collection List"
(Form R-3) in electronic media device within ten (10) days after the applicable month to the nearest SSS branch
office.