Republic of the Philippines R-1 SOCIAL SECURITY SYSTEM EMPLOYER REGISTRATION [™?oreronoweer S COV -01228 (12-2015) TWIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE, THIS CAN ALSO BE DOWNLOADED THRU THE SSS WEBSITE AT www.sss.gov.ph. PLERSE READ THE INSTRUCTIONS AND REMINDERS AT THE BACK BEFORE FILLING OUT THIS FORM, PRINT ALL INFORMATION IN CAPITAL LETTERS /ANO USE BLACK INK ONLY. PART 1- TO BE FILLED OUT BY THE EMPLOYER TYPE OF EMPLOYER Ti susiess Trouser "A, FOR BUSINESS EMPLOYER [BUSINESS NAVE [TAXIOENTIFICATION NUMBER [BUSWESS ADORESS TRITR ATO ¥ BOG FOWET TERETE EBR NOT TTREETAE) ORGS TOROS REPT PRR [zP COE FOREIGN ADDRESS (F FUORI [cOUNTRY [TELEPHONE NUMBER paracansrec oy [EMAIL ADDRESS WEBSITE (rary [START OF OPERATION INUMBER OF EMPLOYEES [NATURE OF BUSINESS [LEGAL PERSONALITY Juoorrm Single Proprietorship Oi corporation 11 | Oi Partnership Ci Cooperative: NAVE OF OWNERIVANAGING PARTNERIPRESIDENTICHAIRMANICORPORATE SECRETARY [POSTTION TITLE (UST NA) (RST NAME) (ACOLE NAME} sur) [WITH PARENT COMPANY? LT YES, maicate Name of Parent Company and ERIO No Ono 'B, FOR HOUSEHOLD EMPLOYER of FAMILY DRIVERIS: ha — aes — TELEPHONE NUMBER iareacove-re. wo) [MOBILE/CELLPHONE NUMBER JNUMBER OF EMPLOYEES |TAX IDENTIFICATION NUMBER (G. CERTIFICATION (FOR BUSINESS/HOUSEHOLD EMPLOYER) Tcertfy that the information provided in this form are true and correct, PRINTED NAME ‘SIGNATURE POSTION TLE DATE, {FOR BUSINESS ENPLOVER) ‘TO BE FILLED OUT BY SSS [BUSNESS CODE FREVIEWEDIOATA CONTROLLED BY “SIGNATURE OVER PRINTED NAME “DATE RTIME ‘SIGNATURE OVER PRINTED NAME “DATE RTINE