Republic of the Philippines

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
ADDRESS
(RM./FLR./UNIT NO. & BLDG. NAME)
(HOUSE/LOT & BLK. NO.)
(STREETNAME)
(BARANGAY/DISTRICT/LOCALITY)
(SUBDIVISION)
(CITY/MUNICIPALITY)
(PROVINCE)
ZIP CODE
TAX IDENTIFICATION NUMBER (TIN)
TELEPHONE NO. (AREA CODE+TEL. NO.)
MOBILE/CELLPHONE NO.
E-MAIL ADDRESS
WEBSITE
TYPE OF PAYOR
EMPLOYEES'
COMPENSATION
CONTRIBUTION
TOTAL
APPLICABLE PERIOD
SOCIAL SECURITY
CONTRIBUTION
HOUSEHOLD EMPLOYER
 BUSINESS EMPLOYER
MONTH
YEAR
P
P
P
FORM OF PAYMENT
AMOUNT PAID IN FIGURES
JANUARY
P
CASH
FEBRUARY
POSTAL MONEY ORDER
MARCH
CHECK
APRIL
CHECK NUMBER
MAY
CHECK DATE
JUNE
BANK/BRANCH NAME
JULY
AUGUST
TOTAL AMOUNT PAID
P
SEPTEMBER
OCTOBER
TOTAL AMOUNT PAID IN WORDS
NOVEMBER
DECEMBER
P
P
P
SUB-TOTAL
UNDER
PAYMENT
ADD
PENALTY
CERTIFIED CORRECT
INTEREST
SIGNATURE
PRINTED NAME
P
P
P
SUB-TOTAL
TOTAL AMOUNT OF PAYMENT
P
DATE
POSITION TITLE
CON- (10-2008)
CON- (10-2008)
(03-2013)
R-5
INSTRUCTIONS
1.
Fill out this form in three (3) copies and accomplish appropriate boxes as follo
ws:
a.
For business employer
-
employernumber,businessname,businessaddressandbusinessTINasregisteredwiththeSSSi
n"Employer Registration" (Form R-1)
b.
For household employer
-
employernumber,householdemployername,homeaddressandpersonalTINasregisteredwithth
eSSS 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 applicabl
e.
4.
Remityourcontributionsfollowingthepaymentdeadlinesbelowforboththebusinessemploye
randhouseholdemployer:
Payment Deadline
If the 10th digit of the
13-digit Employer (ER) number ends in:
(following the applicable month)
1 or 2
10th day of the month
3 or 4
15th day of the month
5 or 6
20th day of the month
7 or 8
25th day of the month
Last day of the month
9 or 0
In case the payment deadline falls on a Saturday, Sunday or holiday, payment may
be on the next working day.
5.
Remit the monthly contributions of your employees/household employees through an
y of the following:
a.
SSS branch office with tellering facility
b.
accredited banks
c.
authorized payment centers
6.
MakeallchecksandpostalmoneyorderspayabletoSSS.Filloutproperlythecheckdetailsinth
e"FormofPayment" portion.
7.
Submitacopyofvalidated"EmployerContributionsPaymentReturn"(FormR-5)or"EmployerCo
ntributionsPaymentReturn"(FormR-5)withSpecialBankReceipt(SBR)togetherwiththecorr
esponding"ContributionCollectionList"(FormR-3)withinten(10)daysaftertheapplicabl
equarteror"ContributionCollectionList"
(FormR-3)inelectronicmediadevicewithinten(10)daysaftertheapplicablemonthtothenea
restSSSbranchoffice.