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Application for Employer Registration Plate
SSS form for registration plate
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
SOCIAL SECURITY SYSTEM
APPLICATION FOR EMPLOYER
REGISTRATION PLATE
COV -
Please read the Instructions/Reminders at the back.
ER NUMBER
NAME OF EMPLOYER
BUSINESS ADDRESS
NO. & STREET
BARANGAY
TOWN/DISTRICT
CITY/PROVINCE
POSTAL CODE
I CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.
PRINTED NAME
SIGNATURE
DATE OF COVERAGE (MONTH/yyyy)
FINDINGS:
OFFICIAL CAPACITY
FOR SS USE
PROCESSED BY/DATE:
DATE
APPROVED BY/DATE:
RECEIVED BY/DATE:
SIGNATURE OVER PRINTED NAME
With different business name/address
Branch but without branch code
REMARKS:
SIGNATURE OVER PRINTED NAME
--------------------------------------------------------------------------------------------------Perforate Here -----------------------------------------------------------------------------------------------
APPLICATION FOR EMPLOYER REGISTRATION PLATE
ACKNOWLEDGMENT STUB
ER NUMBER
DATE OF RELEASE
NAME OF EMPLOYER
RECEIVED BY:
SIGNATURE OVER PRINTED NAME
DATE RECEIVED:
DESIGNATION
RECEIVING BRANCH
INSTRUCTIONS/REMINDERS
1.
Accomplish this form in one (1) copy to be signed by the authorized company official
whether of the main or branch office.
2.
Type or print all information. The business name indicated in this form shall be reflected in
the registration plate.
3.
Pay the fee for the Registration Plate directly to SSS or any of its accredited banks.
4.
Submit the duly accomplished form toegther with the duly validated Miscellaneous Payment
Return (SS Form R-6) or SS Form R-6 with branch's and payor's copies of Special Bank
Receipt to the nearest SSS branch.
5.
The Registration Plate should be picked-up from the SSS branch where this form was
submitted after forty-five (45) days.
6.
Always use the assigned 13-digit ER number in all transactions with the SSS.
