The document is an employment report form from the Social Security System of the Republic of the Philippines. It collects identifying information about employers such as their ID number, name, and address. It also collects personal details of employees like name, date of birth, position, monthly salary, and date of employment. The form includes spaces to report up to 20 employees and requires certification from the employer that the information is correct. Instructions at the bottom specify the reporting requirements, including that all employees must be reported regardless of earnings and that business owners cannot be reported as employees of their own business.

1. R-1A
(REV. 01-2001)
Republic of the Philippines
SOCIAL SECURITY SYSTEM
EMPLOYMENT REPORT
(Please print all information in black ink)
EMPLOYER ID NUMBER REGISTERED EMPLOYER NAME TAXPAYER IDENTIFICATION NO.
ADDRESS POSTAL CODE
SS Number
Name of Employee
(Surname) (Given Name) (MI)
Date of Birth
(MM DD YYYY)
Position Monthly Salary
Date of Employment
(MM DD YYYY)
Remarks
FOR SSS USE
1.
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16.
17.
18.
19.
20.
TOTAL NO. OF
REPORTED
EMPLOYEES
Page of Page/s
u
CERTIFIED CORRECT: FOR SSS USE
PROCESSED BY/DATE:
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
REVIEWED BY/DATE: ENCODED BY/DATE:
RECEIVED BY/DATE:
Signature Over Printed Name
of Authorized Signatory
Official Designation Date
Internet Edition (9/2002)

2. INSTRUCTIONS/REMINDERS
1. Submit in two (2) copies with properly accomplished SS Form R-1 (Employer Registration), if the
employer is not yet registered with the SSS.
2. Submit in two (2) copies to report newly hired/rehired employee/s and present SS Employer ID
Card, if the employer is already registered with the SSS.
3. The employer is obliged to report all its employees for coverage through this form regardless of
their actual amount of monthly earnings rounded off to the last peso.
4. The owner of a single proprietorship business is disqualified to be reported as employee thereof.
However, he may register as self-employed, provided he is not over 60 years old and is currently
not an employee member.
5. Write “Nothing Follows” immediately after the last reported employee.