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Get PH RS-5 2012-2024

Republic of the Philippines RS-5 SOCIAL SECURITY SYSTEM CONTRIBUTIONS PAYMENT RETURN 06-2012 Please read the instructions below before accomplishing this form. Print all information in capital letters and use black ink only. 3. Make all checks payable to SSS and fill out properly the Details of Check Payment portion of the form. 4. SURNAME SS NUMBER NAME THIS IS YOUR OFFICIAL RECEIPT WHEN VALIDATED GIVEN NAME NO. STREET BARANGAY TOWN/DISTRICT ADDRESS CITY/PROVINCE MIDDLE NAME TYPE OF PAYOR Check the appropriate box Self-Employed Voluntary E-MAIL ADDRESS If any POSTAL CODE TELEPHONE/MOBILE NUMBER Overseas Filipino Worker Farmer/Fisherman Non-Working Spouse Foreign Address-City Country APPLICABLE PERIOD INSTRUCTIONS SOCIAL SECURITY 1. Fill out this form in three 3 copies. Month Year 2. Remit your contributions following the payment deadlines below JANUARY P FEBRUARY If 10th digit of the SS number ends in Payment Deadline MARCH following the applicable month or quarter APRIL 1 or 2 10th day of the month MAY 3 or 4 JUNE 5 or 6 JULY 7 or 8 AUGUST 9 or 0 Last day of the month SEPTEMBER For OFW-members OCTOBER - Contributions for January to December of a given year may be paid until 31 December of the same year 31 January of the succeeding year In case the payment deadline falls on a Saturday Sunday or holiday payment may be made on the next working day. Otherwise late contribution payments of self-employed and voluntary members shall be applied prospectively. Fill out the Declaration of Earnings if you desire to change your monthly salary credit MSC to more than two salary brackets or if the change will result to an MSC of lower than P5 000. Please note that if you are 55 years old or older and present MSC is more than P10 000 your allowed increase is only one salary bracket. NOVEMBER DECEMBER TOTAL REMITTANCE TOTAL AMOUNT IN WORDS CERTIFIED CORRECT SIGNATURE OVER PRINTED NAME DETAILS OF CHECK PAYMENT Check No* DATE Date Bank/Branch Name Declaration of Earnings I hereby declare for purposes of Sec* 19-A of the Social Security Law the amount of P as my monthly earnings which shall be the basis of my monthly salary credit to be effective until revised in my next declaration* I affirm under the penalties of perjury that this declaration has been made in good faith and to the best of my knowledge and belief is true and correct. SURNAME SS NUMBER NAME THIS IS YOUR OFFICIAL RECEIPT WHEN VALIDATED GIVEN NAME NO. STREET BARANGAY TOWN/DISTRICT ADDRESS CITY/PROVINCE MIDDLE NAME TYPE OF PAYOR Check the appropriate box Self-Employed Voluntary E-MAIL ADDRESS If any POSTAL CODE TELEPHONE/MOBILE NUMBER Overseas Filipino Worker Farmer/Fisherman Non-Working Spouse Foreign Address-City Country APPLICABLE PERIOD INSTRUCTIONS SOCIAL SECURITY 1. Fill out this form in three 3 copies. Month Year 2. Remit your contributions following the payment deadlines below JANUARY P FEBRUARY If 10th digit of the SS number ends in Payment Deadline MARCH following the applicable month or quarter APRIL 1 or 2 10th day of the month MAY 3 or 4 JUNE 5 or 6 JULY 7 or 8 AUGUST 9 or 0 Last day of the month SEPTEMBER For OFW-members OCTOBER - Contributions for January to December of a given year may be paid until 31 December of the same year 31 January of the succeeding year In case the payment deadline falls on a Saturday Sunday or holiday payment may be made on the next working day. .

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