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Republic of the Philippines

SOCIAL SECURITY SYSTEM

Contribution Collection List


(Please Read Instructions at the back. Print all information in Black Ink)
REGISTERED EMPLOYER NAME

EMPLOYER SS NUMBER

0 3 - 9 2 2 1 4 4 3 TEL. NO.

M M Y Y Y Y
QUARTER ENDING

RED HAMMER CONSTRUCTION AND MAINTENANCE, INC.

ADDRESS

843 - 2604

TYPE OF EMPLOYER

U-19 2/F #2894 FINLANDIA ST COR GALVANI ST BRGY SAN ISIDRO MAKATI CITY
NAME OF MEMBER

SS NUMBER
3 3 0 9 3 9 2 0 7 6

1 2 2 0 1 0

(Surname)

(Given Name)

SALARDA JR

CEFERINO

SOCIAL SECURITY

(MI)

1st Month

2nd Month

Regular

EMPLOYEE COMPENSATION

3rd Month

7 2 8

1st Month

2nd Month

3rd Month

1 0

Household
SEPARATION DATE
(MMDDYYYY)

NH 10112010

PAGE
GRAND TOTAL
Appl. Mo. Social Security
728.00
1st
2nd
3rd

Employee
Compensation

10.00

PROCESSED BY / DATE:

PAYMENT DETAILS
Grand Total

TR/SBR NO.

Date Paid

Amount Paid

738.00

259717

11/10/2010

79,570.00

ENCODED BY / DATE:

FOR
SSS
USE

Signature Over Printed Name

ADJUSTMENT TYPE:

Signature Over Printed Name

OTHER NOTATIONS:

Addition to Previosly
Submitted R-3.
Deduction from Previously
Submitted R-3.

CERTIFIED CORRECT AND PAID:


MANUEL A. PAGTACONAN
Signature Over Printed Name
General Manager
Official Designation
Date

RECEIVED BY/DATE

OF
PAGES

Republic of the Philippines

SOCIAL SECURITY SYSTEM

Contribution Collection List


(Please Read Instructions at the back. Print all information in Black Ink)
REGISTERED EMPLOYER NAME

EMPLOYER SS NUMBER

RED HAMMER CONSTRUCTION AND MAINTENANCE, INC.

0 3 - 9 2 2 1 4 4 3 - 6
TEL. NO.
ADDRESS
843 - 2604

M M Y Y Y Y
QUARTER ENDING
TYPE OF EMPLOYER

U-19 2/F #2894 FINLANDIA ST COR GALVANI ST BRGY SAN ISIDRO MAKATI CITY
NAME OF MEMBER

SS NUMBER

(Surname)

0 3 8 4 8 2 0 1 4 2
0 3 5 2 5 7 1 2 4 5
3 3 8 2 9 8 4 1 4 2

1 2 2 0 1 0

SOCIAL SECURITY

(Given Name)

(MI)

1st Month

2nd Month

NOLI
D
1 BARTOLOME
SONNY
S
2 GAJARDO
HAROLD LLOYD N
3 VENTURA

Regular

EMPLOYEE COMPENSATION

3rd Month
0
0
0

1st Month

2nd Month

3rd Month

0
0
0

Household
SEPARATION DATE
(MMDDYYYY)

SP 10/9/2010
SP 10/9/2010
SP 10/9/2010

5
6

7
8

9
10

11
12

13
14

15

0
GRAND TOTAL
Appl. Mo. Social Security
1st
2nd
3rd

Employee
Compensation

PROCESSED BY / DATE:

PAYMENT DETAILS
Grand Total

TR/SBR NO.

Date Paid

Amount Paid

ENCODED BY / DATE:

FOR
SSS
USE

Signature Over Printed Name

ADJUSTMENT TYPE:

Signature Over Printed Name

OTHER NOTATIONS:

Addition to Previosly
Submitted R-3.
Deduction from Previously
Submitted R-3.

PAGE
CERTIFIED CORRECT AND PAID:
MANUEL A. PAGTACONAN
Signature Over Printed Name
General Manager
12/13/2010
Official Designation
Date

RECEIVED BY/DATE

OF
PAGES

Republic of the Philippines

SOCIAL SECURITY SYSTEM

Contribution Collection List


(Please Read Instructions at the back. Print all information in Black Ink)
REGISTERED EMPLOYER NAME

EMPLOYER SS NUMBER

RED HAMMER CONSTRUCTION AND MAINTENANCE, INC.

0 3 - 9 2 2 1 4 4 3 - 6
TEL. NO.
ADDRESS
843 - 2604

U-19 2/F #2894 FINLANDIA ST COR GALVANI ST BRGY SAN ISIDRO MAKATI CITY

SS NUMBER

(Surname)

3 3 8 4 3 7 4 7 1 8
3 4 2 0 7 1 8 8 8 5
3 3 8 7 2 5 6 3 2 5

SOCIAL SECURITY

(Given Name)

(MI)

AGARIN
RYAN
CATIMBANG JR ARCADIO
SAMAR
JOSE MARVIN

1st Month

2nd Month

GRAND TOTAL

3rd Month

O
A
N

PROCESSED BY / DATE:

PAYMENT DETAILS
Grand Total

TR/SBR NO.

Date Paid

ENCODED BY / DATE:

FOR
SSS
USE

Signature Over Printed Name

ADJUSTMENT TYPE:
Amount Paid

Signature Over Printed Name

OTHER NOTATIONS:

Regular

Household

EMPLOYEE COMPENSATION

TOTALS FOR THIS PAGE (To be filled out on every page)


Employee
Compensation

1 2 2 0 1 0

TYPE OF EMPLOYER

NAME OF MEMBER

Appl. Mo. Social Security


1st
2nd
3rd

M M Y Y Y Y
QUARTER ENDING

Addition to Previosly
Submitted R-3.
Deduction from Previously
Submitted R-3.

1st Month

2nd Month

3rd Month

SEPARATION DATE
(MMDDYYYY)

0
0
0

0 SP = 11/20/2010
0 SP = 11/20/2010
0 SP = 11/20/2010

PAGE
O N E

CERTIFIED CORRECT AND PAID:


MANUEL A. PAGTACONAN
Signature Over Printed Name
General Manager
2/8/2011
Official Designation
Date

RECEIVED BY/DATE

OF
O N E
PAGES

Republic of the Philippines

SOCIAL SECURITY SYSTEM

Contribution Collection List


(Please Read Instructions at the back. Print all information in Black Ink)
REGISTERED EMPLOYER NAME

EMPLOYER SS NUMBER

QUARTER ENDING

RED HAMMER CONSTRUCTION AND MAINTENANCE, INC.

0 3 - 9 2 2 1 4 4 3 - 6
TEL. NO.
ADDRESS
843 - 2604

M M Y Y Y Y

TYPE OF EMPLOYER

U-19 2/F #2894 FINLANDIA ST COR GALVANI ST BRGY SAN ISIDRO MAKATI CITY
NAME OF MEMBER

SS NUMBER

(Surname)

3 3 0 5 2 3 9 0 8 1
3 4 0 0 0 5 2 6 1 3
3 3 5 1 3 9 1 9 0 2

1
2
3

0 9 2 0 1 0

SOCIAL SECURITY

(Given Name)

(MI)

BERONIO
MAXELITO
BIGUEJA
NOEL
BUGARIN JR. ROBERTO

1st Month

A
P
M

2nd Month

Regular

EMPLOYEE COMPENSATION

3rd Month

5 2 0
5 2 0
5 2 0

1st Month

2nd Month

3rd Month

1 0
1 0
1 0

Household
SEPARATION DATE
(MMDDYYYY)

NH = 08/11/2010
NH = 08/11/2011
NH = 08/11/2012

4
5
6
7
8
9
10
11
12
13
14
15

TOTALS FOR THIS PAGE (To be filled out on every page)


GRAND TOTAL
Appl. Mo. Social Security
1st
89,960.00
2nd
3rd

Employee
Compensation

Grand Total

890.00

90,850.00

PROCESSED BY / DATE:

1 5 6 0
PAYMENT DETAILS

TR/SBR NO.

Date Paid

ENCODED BY / DATE:

FOR
SSS
USE

ADJUSTMENT TYPE:
Amount Paid

OTHER NOTATIONS:
PENALTY =

Signature Over Printed Name

Signature Over Printed Name

Addition to Previosly
Submitted R-3.
Deduction from Previously
Submitted R-3.

3 0

PAGE
O N E

CERTIFIED CORRECT AND PAID:


MANUEL A. PAGTACONAN
Signature Over Printed Name
General Manager
Official Designation
Date

RECEIVED BY/DATE

OF
O N E
PAGES