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r1a_fillin_rev - Republic of the Philippines SOCIAL...

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Republic of the Philippines SOCIAL SECURITY SYSTEM EMPLOYMENT REPORT 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) Page ___ of ___ Page/s (Please read instructions/reminders at the back. Print all information in black ink.) Signature Over Printed Name AREA CODE TELEPHONE NUMBER BUSINESS ADDRESS POSTAL CODE NAME OF BUSINESS/EMPLOYER MONTHLY EARNINGS POSITION DATE OF EMPLOYMENT (MM/DD/YYYY) (Surname) (Given Name) (Middle Name) Date I CERTIFY TO THE CORRECTNESS OF ABOVE INFORMATION. RECEIVED/L-501 VERIFIED BY/DATE: EMPLOYER/SS NUMBER NAME OF EMPLOYEE DATE OF BIRTH (MM/DD/YYYY) SS NUMBER Official Designation TYPE OF EMPLOYER Household (HR) Signature Over Printed Name For SSS Use RELATIONSHIP WITH OWNER/ HR ENCODED BY/DATE: TOTAL NO. OF REPORTED EMPLOYEE/S EVALUATED BY/DATE: Signature Over Printed Name Signature Over Printed Name R-1A (03-2008) TYPE OF REPORT Regular Initial Subsequent NAME OF OWNER/MANAGING PARTNER/PRESIDENT/CHAIRMAN:
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