SSSForm Member Loan Payment Return
SSSForm Member Loan Payment Return
03/98)
SBR NO.
Postmark/S & R
Date
Tellers Initials
AMOUNT
EMPLOYER ID NUMBER
EMPLOYEE SS NUMBER
34-1663402-5
EMPLOYERS REGISTERED NAME & ADDRESS
ERIC Y. PERDIGONES
BLK. 192 L.36 PARAISO ST.,
PEMBO, MAKATI CITY
TR. NO.-M.N.
ENTER TYPE OF P
AYMENT BEL
OW (Salary/Calamity/
PA
BELO
Educational/Emergency/Stock Investment Loan):
PAYMENT TYPE
APPLICABLE MONTH
Educational Loan
Enter total amount collected
per collection list
Prior periods
Penalty
Add: Penalty
Prior periods
over payment
Prior periods
under payment
Total Amount
Remitted
NET DUE
INSTRUCTIONS
1. Pay your monthly amortization on the following schedule:
Employer
- on or before the 5th calendar day
following the applicable month.
Self-Employed/Voluntary Member - on or before the last working day of the
applicable month.
2. Always indicate your ID or SS number along with your name and address.
3. Use this form exclusively for your SALARY/CALAMITY/EDUCATIONAL/
EMERGENCY/STOCK INVESTMENT LOAN payments.
4. Always support this form with the SSS official pre-printed collection list to ensure
proper posting of payments. If the employers do not receive the list, please notify the
respective SSS office.
5. Leave employer ID No. blank if individual payment.
PAYMENT MADE IN: (All checks & postal money orders must be
made payable to Social Security System)
Check/PMO: Bank _____________ Check No.________ Date ___________
Cash: P ____________________________
ERIC Y. PERDIGONES
CERTIFIED CORRECT: __________________________________________
(SIGNATURE OVER PRINTED NAME)
Official Designation: ____________________________________________