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R-6 Miscellaneous Payment Return

SSS form used for miscellaneous payment return

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Republic of the Philippines

SOCIAL SECURITY SYSTEM

MISCELLANEOUS PAYMENT FORM
Please read instructions at the back before accomplishing this form.

(02-2011)

(THIS IS YOUR OFFICIAL RECEIPT WHEN VALIDATED.)

Print all information in capital letters and use black ink only.
NAME OF PAYOR
(NO. & STREET)

ADDRESS

(BARANGAY)

(TOWN/DISTRICT)

AMOUNT IN WORDS

(CITY/PROVINCE)

POSTAL CODE

AMOUNT IN FIGURES

TYPE OF PAYMENT
ID Social Security Card

71 Corporate Notes and Bonds

CE Communication Expenses

Specify details

12 Fee for Member's Records

72 Loans to Government Agencies

13 Application Fee - Real Estate Loan

Specify details

14 Inspection/Appraisal Fee

73 Loans to Participating Financial Institutions

40 Study Now Pay Later Plan

Specify loan program

50 Agent Banks' Remittance

74 Direct Loans

8C Sale of Scrap Paper and Garbage

Specify loan program

8D Notarial Fee

75 Sale of Marketable Securities

8F Bidder's Deposit/Performance Bond

Specify details

8G Refund of Salary

76 Dividend of Marketable Securities

8H Refund of Cash Advance

Specify details

8O Refund of Operating Expenses

9A Bidder's Deposit for Other Real Estate Assets

15 Refund of Benefits

Specify details
9B Rental Deposit for Other Real Estate Assets

Specify details
SB Sale of Bid Documents

Specify details
9C Rental for Other Real Estate Assets

Specify project name
RP ER Registration Plate and Sticker

Specify details
9D Sale of Other Real Estate Assets

Specify details
DB Deposit from Depository Banks

Specify details
8Q Others

Specify account details

Specify details

FORM OF PAYMENT
Cash

PREPARED BY

P

Postal Money Order (PMO)
Check
Check Number
Date

SIGNATURE OVER PRINTED NAME

Bank/Branch Name
TOTAL

P

DATE
 
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