Republic of the Philippines VR 4 SOCIAL SECURITY SYSTEM [EMPLOYERID NUMBER COV - 01228 (12.2015) "THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE. THIS CAN ALSO BE DOWNLOADED THRU THE SSS WEBSITE AT www.ses.9ov- PLEASE READ THE INSTRUCTIONS AND REMINDERS AT THE GACK BEFORE FILLING OUT THIS FORM PRINT ALL INFORMATION IN CAPITAL LETTERS: AND USE BLACK INK ONLY, PART 1- T0 BE FILLED OUT BY THE EMPLOYER [Vee OF ENPLOYER Tisusiness Tiveusenod ‘A_FOR BUSINESS EMPLOYER, [SUSRESS NAME ITAXIDENTIFICATION NUMBER ritiitittit ISUSNESS ADDRESS TRENT REDS RANEY POUSLOTERR NOT TREE) oo TNS TERING, TROVE [a COE FOREIGN ADDRESS Wr aPracARE) [COUNTRY [TELEPHONE NUMBER wencoocre nor [E-MAT ADDRESS WEBSITE Fam Litiiiity rene TD Sige Propels 1 corerton tlititty Partnership Cooperative NAME OF OWNERIMUANAGING PARTNERIPRESIDEN TICHAIRMANICORPORATE SECRETARY POSTION TITLE (UST mAMe) (HST NAME). MoOLENAwe} (SUEFX: ITH PARENT COMPANY? LI YES, ineicate Nore of Parent Company and ER ION Gno FOR HOUSEHOLD ENPLOYER of FAMILY ORIVERIS TRUER THOS TET TORLOTTRR WOT BREET RT TST ERENT TTROTGEATAT TERRE PROSE [zP CODE EMAIL ADDRESS [TELEPHONE NUMBER pcs cooe-ra-way J MOBTLEICELLPHONE NUMBER INOWBER OF EPLOVEES [FAX IDENTIFICATION NUMBER ee ea | ey (C, CERTIFICATION (FOR BUSINESSIHOUSEHOLD EMPLOYER) eerily that the information provided in this form are true and correct. PRINTED RAME ‘SIGNATURE POSITION TITLE SUSNESS CODE JSCREENEDIRECEIVEDIPROCESSED BY SIGNATURE OVERPRINTEDNAWE “DATE ATIME SIGNATURE OVERPRINTED NAVE © DATE RTINEINSTRUCTIONS. 1. Fill out this form in two (2) copies and accomplish appropriate parts as follows: For Busines Employer For Household Employer of family driveris. ~ Part -A > Part lB 2. In fling out the box for Tax Identification Number (TIN) in Part IA ofthe form, please fil out as follows: = Business TIN, if business employer = Personal TIN, if household employer 3. For the 'Statt of Operation" and "Number of Employees" boxes, il out the required data, as follows: Start of Operation = Number of Employees ‘exact date of start of business operation/date of employment of family driver ‘actual number of employees upon registration with SSS, if any ‘Always indicate "N/A" or "Not Applicable’, ifthe required data is not applicable. ‘Always affix initials on all erasures/alterations on this form. Present vali identification cards/documents. Refer to attached "List of Filers Valid Identification (ID) Cards/Documents~ Write the Employer ID Number and Employer Name in all pages ofall identification cardsidocuments. ‘Submit this form to the nearest SSS branch office withthe supporting documents, Refer tothe attached List of Documentary Requirements, ‘This form shall be signed by the following authorized signatories: 9.1 For Business Employer 982 For Household Employer of Family Drivers TEGAL PERSONALITY ‘AUTHORIZED SIGNATORY ‘SUPPORTING DOCUMENTS. [A Single Proprietorship ‘Owner or, in__his her absence, _any|Any ofthe following representative with valid Special Power of ‘Attorney (SPA) 1, Certificate of Registration of Business Name from the Department of Trade and Industry (DTI) 2_ Business Permit from the Municipal Office I Parinerehip Wianaging Partner [Approved Aricles of Partnership from Incorporation from Securities and Exchange |Commission (SEC) IE Corparation Including non stock!non-profit corporations Foreign-owned corporation Manning agency with foreign princi President, Chaitman or Corporate Secretary ‘The designated Philippine representative as shown in the SEC registration President, Chairman of Corporate Secretary [Approved Articles of Incorporation rom SEC 1, “Approved Articles of Incorporation from SEC; and la. License to Transact Business in the Philippines from SEC 1. Approved Articles of Incorporation from SEC; and la. Agency Agreement between the manning ‘agency and foreign principal [Cooperative Manpower service cooperative ‘Ghaliman or Corporate Secretary ‘Chairman or Corporate Secretary [Approved Aricies of Cooperation from the [Cooperative Development Authority (CDA) }1. Approved Aticles of Cooperation from ‘CDA; and ]2. Accreditation from the Department of Labor and Employment (DOLE) 40. Report all your employees for SS coverage within tity (30) days from the date of their employment by submitting an accomplished "Employment Report" (SS Form R-1A) to the nearest SSS branch office. Pleese be reminded that failure to report your employ ‘shall render you liable for damages equivalent to the benefits to which said employeels would have be the employeets been reported on time. (Sec. 24 of RA. 8282). is within the prescribed period entitled in case of any contingency had 11, Separation of your emplayee/s should be reported by submiting an accomplished "Employment Report form. REMINDERS 1, Always use your correct Employer Number in all your transactions with SSS. 2. Notify the nearest SSS branch office using the "Employer Data Chenge Request" (SS Form R-8) to update your date/records with the SSS. This will expecite your transactions with SSS and avoid the possibiity of being billed of unpaid contributions in case of temporary suspension or cessation of business operation 44. Verification of status may be made thru the SSS website at www sss.gov ph or contact our Call Center at 920-6446 up to 55 or 917-7777,LIST OF FILER'S VALID IDENTIFICATION (ID) CARDS/DOCUMENTS. EMPLOYER REGISTRATION FORM (SS FORM R-1) slanalory of the SS Form R-t OR ‘Two (2) Secondary ID cards/documents of the authorized signatory of the SS Form R-t [both with signature and at least one (1) with photo) FILED BY ‘BUSINESS/HOUSEHOLD IDENTIFICATION REQUIREMENTS ee evens REPRESENTATIVE F— One (1) Primary ID cardldocument of the authorized. v vy (Present the original.) (Present the original & ‘submit the photocopy.) One (1) Primary 0 cardidocumentof te v representative ofthe authorized signatory of the (Present the original & reqistraton form, submit the photocopy.) oR Two (2) Secondary ID cards/documents of ‘representative ofthe authorized signatory of the SS Form Rt [5 Authorization Letter v Submit the original ‘Note: If fled personally by the Household Employer, no ID card/document is required, Primary ID Cards/Documents Driver's License Passport Professional Regulation Commission (PRC) Card ‘Seaman's Book (Seafarers Identification & Record Book) Social Secutty (SS) Card Unified Mutt-Purpose ID (UMID) Card 1. Secondary ID Cards/Documents 1 2 ‘Alion Cerificate of Registration Certificate from any of the following, whichever is applicable: > National Commission on Indigenous Peoples > National Commission on Muslim Filipinos. Cerificate of Licensure/Qualification Documents from Maritime Industry Authority ‘Company ID Card Great Card Firearm License Card issued by Philippine "National Police (PNP) Fishworkers License issued by Bureau of Fisheries ‘and Aquatic Resources (BFAR) Government Service Insurance System (GSIS) Card/Member's Record/Certificate of Membership 9. Health or Medical Card 410. Homeowners Association ID Card 11. ID Gard issued by Local Government Units (LGUs) (e.g, Barangay/Municipalty/City) 12 13, 14, 18 16 7. 18 19 2 23. 24. ID Card issued by professional association recognized by PRC Marriage ContractMarriage Certificate Overseas Worker Welfare Administration (OWWA) Card Pag-IBIG Members Data Form or Transaction Card Philippine Health Insurance Corporation (PHIC) ID Card! Members Data Record Police Clearance: Postal ID Card ‘School ID Card Seafarers Registration Certificate issued by Philippine Overseas Employment Administration (POEA) ‘Senior Citizen Card Student Permit issued by Land Transportation Office (LTO) ‘Taxpayey's identification Number (TIN) Card Voter's Identification Card/AfidavitCertificate of Registration