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SSS FORM ML-1(Rev.

03/98)

(This is your official receipt when validated)

Republic of the Philippines

SOCIAL SECURITY SYSTEM


MONTHL
Y -SALARY/CALAMITY/EDUCATIONAL/
MONTHLY
EMERGENCY/STOCK INVESTMENT LOAN
P A Y M E N T R E T U R N

SBR NO.

Postmark/S & R

Date

Tellers Initials

AMOUNT

(To be submitted in 3 copies)


DATE

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

(FOR SSS USE ONLY- Do not alter or change amount printed


in this box)
Amount due per collection list

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

Less: Over Payment

Prior periods
under payment

Add: Under Payment

Total Amount
Remitted

Please pay on or before

NET DUE

Total amount remitted in words

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: ____________________________________________

Internet Edition (1/2003)

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