Republic of the Philippines

R-5
CON-

(10-2008)
(03-2013)

SOCIAL SECURITY SYSTEM

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 -

PHILFAST GLOBAL FORWARDING INC.

(RM./FLR./UNIT NO. & BLDG. NAME)

ADDRESS

(HOUSE/LOT & BLK. NO.)

(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

TAX IDENTIFICATION NUMBER (TIN)

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

AMOUNT PAID IN FIGURES

FORM OF PAYMENT

CASH

MARCH

POSTAL MONEY ORDER

CHECK

APRIL
MAY

CHECK NUMBER

JUNE

CHECK DATE

JULY

BANK/BRANCH NAME

9, 075.00
63885393
2/12/2015
ALLIED BANK

AUGUST
SEPTEMBER

TOTAL AMOUNT PAID

9, 075.00

OCTOBER
NOVEMBER

TOTAL AMOUNT PAID IN WORDS

DECEMBER

8,965.00

110.00

9,075.00

NINE THOUSAND SEVENTY FIVE PESOS

ONLY.

PENALTY

CERTIFIED CORRECT

SALVADOR B. SLVA JR III

INTEREST

ADD

UNDER
PAYMENT

SUB-TOTAL

SUB-TOTAL
CON(10-2008)

PRINTED NAME

TOTAL AMOUNT OF PAYMENT

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.