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EMPLOYER SS NUMBER
0 3 - 9 2 2 1 4 4 3 TEL. NO.
M M Y Y Y Y
QUARTER ENDING
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
ADJUSTMENT TYPE:
OTHER NOTATIONS:
Addition to Previosly
Submitted R-3.
Deduction from Previously
Submitted R-3.
RECEIVED BY/DATE
OF
PAGES
EMPLOYER SS NUMBER
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
ADJUSTMENT TYPE:
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
EMPLOYER SS NUMBER
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
ADJUSTMENT TYPE:
Amount Paid
OTHER NOTATIONS:
Regular
Household
EMPLOYEE COMPENSATION
1 2 2 0 1 0
TYPE OF EMPLOYER
NAME OF MEMBER
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
RECEIVED BY/DATE
OF
O N E
PAGES
EMPLOYER SS NUMBER
QUARTER ENDING
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
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 =
Addition to Previosly
Submitted R-3.
Deduction from Previously
Submitted R-3.
3 0
PAGE
O N E
RECEIVED BY/DATE
OF
O N E
PAGES