RF1

PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
ADRIANO
EDUARDO
AGUDO
EVELYN
AQUINO
WILLIAM
BADE
BONIFACIO
BAUTISTA
ROMNICK PAOLO
BEQUIZO
EDITHA
BONDOC
LEILANI
BRAVO
MARIE PEACHY
BRILLANTES
JUANITA
BUAN
FELICITAS
BUTUHAN
CIRIACO
CALDERON
GERARDO
CASTRO
RONNEL
CAUILAN
GIRLIE
CENTENO
ROLANDO
CONCEPCION
HENRY
CORPUZ
RODOLFO
CORREA
FILIPINAS
CORREA
TERESITA
CRUZ
IVETTE
CRUZ
LUZVIMINDA
CUSTODIO
RODRIGO
DANIEL
RAMEL
DE JESUS
PAG-ASA
DELA CRUZ
JOSIE
DELA CRUZ
MA. CECILIA
DELA PAZ
FLORENCIA
DELA PAZ
NERIZA
DELOS REYES
CHRISTOPHER
DIMLA
MA. VICTORIA
DIZON
NIMFA
ENRIQUEZ
JULFA
ESPIRITU
PURIFICACION

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
P
DG
S
M
S
E
C
DG
H
B
R
C
P
S
DL
Q
H
M
R
Y
O
V
DB
T
E
SR
V
S
V
V
C
V
M

PIN/SSS
1ST 2ND 3RD
190001406942
8
8
8
190001403692 27 27 27
190001410486
5
5
5
190001401010 27 27 27
072007523530
6
6
6
190001410729 16 16 16
190001408635 27 27 27
070001227481
7
7
7
190001408848
7
7
7
190001408317 27 27 27
190001406691
5
5
5
070000713196
5
5
5
210000061128 12 12 12
190001407655
8
8
8
210000071646 27 27 27
190001408570 27 27 27
190001408694
9
9
9
190001408589
9
9
9
190001400170
8
8
8
190001411407 12 12 12
190001411938 12 12 12
070000542855 27 27 27
190001399768 27 27 27
190001409194 27 27 27
190001408767 15 15 15
070000167744 12 12 12
070000779782 11 11 11
190001410818 15 15 15
070000832861
5
5
5
072003142206
4
4
4
190001409496
7
7
7
190001404788
8
8
8
Page 1 of8 40 8
190001405687
8

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
237.50
237.50
237.50
237.50
237.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
225.00
225.00
225.00
225.00
225.00
187.50
187.50
187.50
187.50
187.50
175.00
175.00
175.00
175.00
175.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
ESTRELLA
RHEA
EUSEBIO
ILDEFONSA
EVANGELISTA
JOHN CARLO
EVANGELISTA
MARISSA
FRANCISCO
ZENAIDA
GALVEZ
ALEXANDER
GALVEZ
MERCEDITA
GARDOSE
CENONA
GATCHALIAN
ANGELITA
GIANAN
DOMINGO
GIMENO
LOLITA
GIPA
MA. MARIZA
GONZALES
ALEXANDER
GUANSING
AILE
GUILLERMO
ROBERTO
ILETO
GRACIELA
ILLESCAS
RENE ANTHONY
ILUSTRISIMO
NILDA
INDUCIL
EDELMIRA
JOSE
BENILDA
JOSON
REYNANTE
LABANAN
DONATILIA
LEGASPI
MYRNA
LLAMADO
LORELIE
LLAMADO
MA. CARIDAD
MALIWAT
HECTOR
MANAHAN
SILVERIO
MANANGUIT
ELIZABETH
MANIO
ARNOLD
MARCOSO
EDELITA
MENDOZA
ARIEL
MENDOZA
CORAZON
MENDOZA
ESPERANZA

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
G
DG
G
V
P
J
P
E
A
S
V
C
V
A
S
C
B
V
S
O
DC
V
V
N
E
B
V
V
S
B
U
P
P

PIN/SSS
1ST 2ND 3RD
070000765757
5
5
5
190001409402
8
8
8
072011641599
4
4
4
190001411571 12 12 12
190001411156 13 13 13
27 27 27
190001410540 27 27 27
190001409968 10 10 10
190001400359
8
8
8
070000713234
5
5
5
210000040597 10 10 10
190515135875
7
7
7
190002400049 12 12 12
190001403951 26 26 26
190001408945
6
6
6
190001410230
5
5
5
070000779774 11 11 11
190001409704
8
8
8
190001403846 11 11 11
070000167752
6
6
6
190258175798 10 10 10
190001408600
7
7
7
190001410281
5
5
5
190001411512 12 12 12
070000765528
7
7
7
070000765269 15 15 15
190001399334
5
5
5
190001411334 12 12 12
190001409275
8
8
8
190001410915 12 12 12
190001403390
9
9
9
190000321250
4
4
4
190001407949
7
7
7
Page 2 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
100.00
100.00
100.00
100.00
100.00
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
187.50
187.50
187.50
187.50
187.50
200.00
200.00
200.00
200.00
200.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
100.00
100.00
100.00
100.00
100.00
162.50
162.50
162.50
162.50
162.50
125.00
125.00
125.00
125.00
125.00
187.50
187.50
187.50
187.50
187.50
362.50
362.50
362.50
362.50
362.50
112.50
112.50
112.50
112.50
112.50
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
175.00
175.00
175.00
112.50
112.50
112.50
112.50
112.50
162.50
162.50
162.50
162.50
162.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
137.50
187.50
187.50
187.50
187.50
187.50
150.00
150.00
150.00
150.00
150.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
MIGUEL
PRISCILLA
MIGUEL
ROBERT
PADILLA
MANUEL
PANGILINAN
ADORACION
PASTRANA
ESTELITA
PAULINO
JOANNE
PERUEL
LEONILA
PILE
AGUSTIN
QUIZON
JOSEFINA
REGALA
YOLANDA
REYES
LYDIA
REYES
ROSITA
REYES
ZENAIDA
RIVERA
MA. TERESA
RIVERA
ORLANDO
SALVADOR
GRACE
SALVADOR
RODERICK
SAMANIEGO
BONIFARTE
SANCHEZ
MARILYN
SANCHEZ
MARVIN
SANTIAGO
FERDINAND
SANTIAGO
MARIBETH
SANTOS
LAZARO
SANTOS
PERLA
SARRONDO
LUIS
SAYCO
MARINA
SESE
RICARDO JR
SICAT
LOLITA
STA. ANA
LOLITA
TADEO
SONIA
TAN
PAULA CARLA
TOLENTINO
EMILYN

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
S
M
P
C
P
M
C
I
L
C
T
V
C
N
V
M
S
R
V
I
A
S
E
P
T
V
G
T
F
C
G
L

PIN/SSS
1ST 2ND 3RD
190001411660 12 12 12
210000075013 27 27 27
190001405547 27 27 27
190001401568
5
5
5
070000167914
6
6
6
190001411261 15 15 15
070000167930 10 10 10
190001405903
6
6
6
190001407523 15 15 15
070000167779 11 11 11
190001409577
5
5
5
070000167787 11 11 11
070001227473 11 11 11
070001011462 10 10 10
190001399911
9
9
9
070000632013
8
8
8
190001401010 27 27 27
190001410141
5
5
5
190001404362 27 27 27
190001410702 16 16 16
070001078451
8
8
8
070251467658
4
4
4
210000071883 27 27 27
070000765595
7
7
7
27 27 27
070251667894
6
6
6
190001410821 17 17 17
070000631998
7
7
7
190001409836
8
8
8
190001408457
7
7
7
070252006733 27 27 27
070000765404
8
8
8
Page 3 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
162.50
162.50
162.50
162.50
162.50
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
175.00
175.00
175.00
175.00
175.00
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
162.50
162.50
162.50
162.50
162.50
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
237.50
237.50
237.50
237.50
237.50
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
250.00
250.00
250.00
250.00
250.00
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

Action taken:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128

USE

Date Received:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
TORRES
FELIPE
VALMADRID
ELIZABETH
VALMADRID
ILDEFONSO
VALMADRID
ISAIAS JR
VALMADRID
ROEL
VANGUARDIA
ESTRELL
VASALLO
WILMA
VELILLA
ANTHONY
VENDIVIL
ANICIA
VENDIVIL
ANTONINA
VERDIDO
EDILBERTO
VICTORIA
EDELUISA
VICTORIA
JAIME
VICTORIO
SHERWIN
VILLACORTE
ANABELLE
VILLACORTE
ENRIQUE
VILLANUEVA
BIBIAN
VILLANUEVA
DESAREE
VILLANUEVA
MA. TERESA
VIOLAGO
NUMERIANO
ZURBITO
SAMSON
TIANGCO
MA. LOURDES
CRUZ
ALVIN
ESPIRITU
MARVIN DALE
SAMSON
RENITA
SANTOS
REY
VALMADRID
CORAZON
SANTOS
FRANCIS EDWARD
CRUZ
ROMINA
REYES
MARK LESTER
TOTAL

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
V
T
M
V
M
F
S
DG
P
P
V
R
S
V
B
C
B
C
V
M
A
C
V
B
T
E
V
N
O
P

PIN/SSS
1ST 2ND 3RD
190001406624
5
5
5
190001398958
9
9
9
072008918989 10 10 10
070250741381
4
4
4
27 27 27
070000167795 11 11 11
190001400502
9
9
9
190258175998 10 10 10
190001411016 12 12 12
190001399199
7
7
7
190001406373
5
5
5
190001407760
7
7
7
190001405245
5
5
5
070001057497 27 27 27
190001409372
7
7
7
27 27 27
190001402211
8
8
8
072003121519 11 11 11
190001400618 12 12 12
190001410435
5
5
5
190001402769
5
5
5
11 11 11
4
4
4
10 10 10
8
8
8
8
8
8
6
6
6
6
6
6
6
6
6
27 27 27
Page 4 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
100.00
100.00
100.00
100.00
100.00
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00
175.00
175.00
175.00
175.00
175.00
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
175.00
175.00
175.00
187.50
187.50
187.50
187.50
187.50
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
87.50
87.50
87.50
87.50
87.50
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
375.00
375.00
375.00
375.00
375.00
23,750.00 23,750.00 23,750.00 23,750.00 23,750.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

Action taken:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48
NAME OF EMPLOYEES
SURNAME
GIVEN NAME

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI

PIN/SSS

1ST 2ND 3RD

1ST MONTH
PS
ES

GOVERNMENT
REGULAR RF1

NHIP PREMIUM CONTRIBUTIONS

2ND MONTH
3RD MONTH
PS
ES
PS

CERTIFIED CORRECT :
ARIEL U. MENDOZA
H.R.M.O. IV

Page 5 of 40

APPLICABLE QUARTER

TIONS

APPLICABLE QUARTER
YEAR:

1ST
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
137.50
375.00
100.00
375.00
112.50
237.50
375.00
125.00
125.00
375.00
100.00
100.00
187.50
137.50
375.00
375.00
150.00
150.00
137.50
187.50
187.50
375.00
375.00
375.00
225.00
187.50
175.00
225.00
100.00
87.50
125.00
137.50
137.50

Page 6 of 40

TIONS

APPLICABLE QUARTER
YEAR:

1ST
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
100.00
137.50
87.50
187.50
200.00
375.00
375.00
162.50
137.50
100.00
162.50
125.00
187.50
362.50
112.50
100.00
175.00
137.50
175.00
112.50
162.50
125.00
100.00
187.50
125.00
225.00
100.00
187.50
137.50
187.50
150.00
87.50
125.00

Page 7 of 40

TIONS

APPLICABLE QUARTER
YEAR:

1ST
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
187.50
375.00
375.00
100.00
112.50
225.00
162.50
112.50
225.00
175.00
100.00
175.00
175.00
162.50
150.00
137.50
375.00
100.00
375.00
237.50
137.50
87.50
375.00
125.00
375.00
112.50
250.00
125.00
137.50
125.00
375.00
137.50

Page 8 of 40

TIONS

APPLICABLE QUARTER
YEAR:

1ST
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
100.00
150.00
162.50
87.50
375.00
175.00
150.00
162.50
187.50
125.00
100.00
125.00
100.00
375.00
125.00
375.00
137.50
175.00
187.50
100.00
100.00
175.00
87.50
162.50
137.50
137.50
112.50
112.50
112.50
375.00
23,750.00

Page 9 of 40

APPLICABLE QUARTER
YEAR:

TIONS

1ST
2011

REMARKS
3RD MONTH
ES

SP-Separated, NE- No Earnings

NH-Newly Hired

Page 10 of 40

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
ADRIANO
EDUARDO
AGUDO
EVELYN
AQUINO
WILLIAM
BADE
BONIFACIO
BAUTISTA
ROMNICK PAOLO
BEQUIZO
EDITHA
BONDOC
LEILANI
BRAVO
MARIE PEACHY
BRILLANTES
JUANITA
BUAN
FELICITAS
BUTUHAN
CIRIACO
CALDERON
GERARDO
CASTRO
RONNEL
CAUILAN
GIRLIE
CENTENO
ROLANDO
CONCEPCION
HENRY
CORPUZ
RODOLFO
CORREA
FILIPINAS
CORREA
TERESITA
CRUZ
IVETTE
CRUZ
LUZVIMINDA
CUSTODIO
RODRIGO
DANIEL
RAMEL
DE JESUS
PAG-ASA
DELA CRUZ
JOSIE
DELA CRUZ
MA. CECILIA
DELA PAZ
FLORENCIA
DELA PAZ
NERIZA
DELOS REYES
CHRISTOPHER
DIMLA
MA. VICTORIA
DIZON
NIMFA
ENRIQUEZ
JULFA
ESPIRITU
PURIFICACION

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
P
DG
S
M
S
E
C
DG
H
B
R
C
P
S
DL
Q
H
M
R
Y
O
V
DB
T
E
SR
V
S
V
V
C
V
M

PIN/SSS
1ST 2ND 3RD
190001406942
8
8
8
190001403692 27 27 27
190001410486
5
5
5
190001401010 27 27 27
072007523530
6
6
6
190001410729 16 16 16
190001408635 27 27 27
070001227481
7
7
7
190001408848
7
7
7
190001408317 27 27 27
190001406691
5
5
5
070000713196
5
5
5
210000061128 12 12 12
190001407655
8
8
8
210000071646 27 27 27
190001408570 27 27 27
190001408694
9
9
9
190001408589
9
9
9
190001400170
8
8
8
190001411407 12 12 12
190001411938 12 12 12
070000542855 27 27 27
190001399768 27 27 27
190001409194 27 27 27
190001408767 15 15 15
070000167744 12 12 12
070000779782 11 11 11
190001410818 15 15 15
070000832861
5
5
5
072003142206
4
4
4
190001409496
7
7
7
190001404788
8
8
8
Page 11 of
190001405687
8 40 8
8

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
237.50
237.50
237.50
237.50
237.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
225.00
225.00
225.00
225.00
225.00
187.50
187.50
187.50
187.50
187.50
175.00
175.00
175.00
175.00
175.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
ESTRELLA
RHEA
EUSEBIO
ILDEFONSA
EVANGELISTA
JOHN CARLO
EVANGELISTA
MARISSA
FRANCISCO
ZENAIDA
GALVEZ
ALEXANDER
GALVEZ
MERCEDITA
GARDOSE
CENONA
GATCHALIAN
ANGELITA
GIANAN
DOMINGO
GIMENO
LOLITA
GIPA
MA. MARIZA
GONZALES
ALEXANDER
GUANSING
AILE
GUILLERMO
ROBERTO
ILETO
GRACIELA
ILLESCAS
RENE ANTHONY
ILUSTRISIMO
NILDA
INDUCIL
EDELMIRA
JOSE
BENILDA
JOSON
REYNANTE
LABANAN
DONATILIA
LEGASPI
MYRNA
LLAMADO
LORELIE
LLAMADO
MA. CARIDAD
MALIWAT
HECTOR
MANAHAN
SILVERIO
MANANGUIT
ELIZABETH
MANIO
ARNOLD
MARCOSO
EDELITA
MENDOZA
ARIEL
MENDOZA
CORAZON
MENDOZA
ESPERANZA

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
G
DG
G
V
P
J
P
E
A
S
V
C
V
A
S
C
B
V
S
O
DC
V
V
N
E
B
V
V
S
B
U
P
P

PIN/SSS
1ST 2ND 3RD
070000765757
5
5
5
190001409402
8
8
8
072011641599
4
4
4
190001411571 12 12 12
190001411156 13 13 13
27 27 27
190001410540 27 27 27
190001409968 10 10 10
190001400359
8
8
8
070000713234
5
5
5
210000040597 10 10 10
190515135875
7
7
7
190002400049 12 12 12
190001403951 26 26 26
190001408945
6
6
6
190001410230
5
5
5
070000779774 11 11 11
190001409704
8
8
8
190001403846 11 11 11
070000167752
6
6
6
190258175798 10 10 10
190001408600
7
7
7
190001410281
5
5
5
190001411512 12 12 12
070000765528
7
7
7
070000765269 15 15 15
190001399334
5
5
5
190001411334 12 12 12
190001409275
8
8
8
190001410915 12 12 12
190001403390
9
9
9
190000321250
4
4
4
190001407949
7
7
7
Page 12 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
100.00
100.00
100.00
100.00
100.00
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
187.50
187.50
187.50
187.50
187.50
200.00
200.00
200.00
200.00
200.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
100.00
100.00
100.00
100.00
100.00
162.50
162.50
162.50
162.50
162.50
125.00
125.00
125.00
125.00
125.00
187.50
187.50
187.50
187.50
187.50
362.50
362.50
362.50
362.50
362.50
112.50
112.50
112.50
112.50
112.50
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
175.00
175.00
175.00
112.50
112.50
112.50
112.50
112.50
162.50
162.50
162.50
162.50
162.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
137.50
187.50
187.50
187.50
187.50
187.50
150.00
150.00
150.00
150.00
150.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
MIGUEL
PRISCILLA
MIGUEL
ROBERT
PADILLA
MANUEL
PANGILINAN
ADORACION
PASTRANA
ESTELITA
PAULINO
JOANNE
PERUEL
LEONILA
PILE
AGUSTIN
QUIZON
JOSEFINA
REGALA
YOLANDA
REYES
LYDIA
REYES
ROSITA
REYES
ZENAIDA
RIVERA
MA. TERESA
RIVERA
ORLANDO
SALVADOR
GRACE
SALVADOR
RODERICK
SAMANIEGO
BONIFARTE
SANCHEZ
MARILYN
SANCHEZ
MARVIN
SANTIAGO
FERDINAND
SANTIAGO
MARIBETH
SANTOS
LAZARO
SANTOS
PERLA
SARRONDO
LUIS
SAYCO
MARINA
SESE
RICARDO JR
SICAT
LOLITA
STA. ANA
LOLITA
TADEO
SONIA
TAN
PAULA CARLA
TOLENTINO
EMILYN

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
S
M
P
C
P
M
C
I
L
C
T
V
C
N
V
M
S
R
V
I
A
S
E
P
T
V
G
T
F
C
G
L

PIN/SSS
1ST 2ND 3RD
190001411660 12 12 12
210000075013 27 27 27
190001405547 27 27 27
190001401568
5
5
5
070000167914
6
6
6
190001411261 15 15 15
070000167930 10 10 10
190001405903
6
6
6
190001407523 15 15 15
070000167779 11 11 11
190001409577
5
5
5
070000167787 11 11 11
070001227473 11 11 11
070001011462 10 10 10
190001399911
9
9
9
070000632013
8
8
8
070000366744 27 27 27
190001410141
5
5
5
190001404362 27 27 27
190001410702 16 16 16
070001078451
8
8
8
070251467658
4
4
4
210000071883 27 27 27
070000765595
7
7
7
210250408794 27 27 27
070251667894
6
6
6
190001410821 17 17 17
070000631998
7
7
7
190001409836
8
8
8
190001408457
7
7
7
27 27 27
070000765404
8
8
8
Page 13 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00
NE-No Earnings
100.00
100.00
100.00
100.00
100.00
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
162.50
162.50
162.50
162.50
162.50
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
175.00
175.00
175.00
175.00
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
162.50
162.50
162.50
162.50
162.50
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
237.50
237.50
237.50
237.50
237.50
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
250.00
250.00
250.00
250.00
250.00
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

Action taken:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128

USE

Date Received:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
TORRES
FELIPE
VALMADRID
ELIZABETH
VALMADRID
ILDEFONSO
VALMADRID
ISAIAS JR
VALMADRID
ROEL
VANGUARDIA
ESTRELL
VASALLO
WILMA
VELILLA
ANTHONY
VENDIVIL
ANICIA
VENDIVIL
ANTONINA
VERDIDO
EDILBERTO
VICTORIA
EDELUISA
VICTORIA
JAIME
VICTORIO
SHERWIN
VILLACORTE
ANABELLE
VILLACORTE
ENRIQUE
VILLANUEVA
BIBIAN
VILLANUEVA
DESIREE
VILLANUEVA
MA. TERESA
VIOLAGO
NUMERIANO
ZURBITO
SAMSON
TIANGCO
MA. LOURDES
CRUZ
ALVIN
ESPIRITU
MARVIN DALE
SAMSON
RENITA
SANTOS
REY
VALMADRID
CORAZON
SANTOS
FRANCIS EDWARD
CRUZ
ROMINA
REYES
MARK LESTER
TOTAL

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
V
T
M
V
M
F
S
DG
P
P
V
R
S
V
B
C
B
C
V
M
A
C
V
B
T
E
V
N
O
P

PIN/SSS
1ST 2ND 3RD
190001406624
5
5
5
190001398958
9
9
9
072008918989 10 10 10
070250741381
4
4
4
27 27 27
070000167795 11 11 11
190001400502
9
9
9
190258175998 10 10 10
190001411016 12 12 12
190001399199
7
7
7
190001406373
5
5
5
190001407760
7
7
7
190001405245
5
5
5
070001057497 27 27 27
190001409372
7
7
7
210000044991 27 27 27
190001402211
8
8
8
072003121519 11 11 11
190001400618 12 12 12
190001410435
5
5
5
190001402769
5
5
5
190506244890 11 11 11
4
4
4
10 10 10
007025290753
8
8
8
212000202441
8
8
8
6
6
6
210250313718
6
6
6
6
6
6
27 27 27
Page 14 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
100.00
100.00
100.00
100.00
100.00
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00
175.00
175.00
175.00
175.00
175.00
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
175.00
175.00
175.00
187.50
187.50
187.50
187.50
187.50
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
87.50
87.50
87.50
87.50
87.50
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
375.00
375.00
375.00
375.00
375.00
23,375.00 23,375.00 23,375.00 23,375.00 23,200.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

Action taken:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48
NAME OF EMPLOYEES
SURNAME
GIVEN NAME

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI

PIN/SSS

1ST 2ND 3RD

1ST MONTH
PS
ES

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

2ND MONTH
3RD MONTH
PS
ES
PS

CERTIFIED CORRECT :
ARIEL U. MENDOZA
H.R.M.O. IV

Page 15 of 40

APPLICABLE QUARTER
YEAR:

TIONS

2ND
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
137.50
375.00
100.00
375.00
112.50
237.50
375.00
125.00
125.00
375.00
100.00
100.00
187.50
137.50
375.00
375.00
150.00
150.00
137.50
187.50
187.50
375.00
375.00
375.00
225.00
187.50
175.00
225.00
100.00
87.50
125.00
137.50
137.50

Page 16 of 40

APPLICABLE QUARTER
YEAR:

TIONS

2ND
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
100.00
137.50
87.50
187.50
200.00
375.00
375.00
162.50
137.50
100.00
162.50
125.00
187.50
362.50
112.50
100.00
175.00
137.50
175.00
112.50
162.50
125.00
100.00
187.50
125.00
225.00
100.00
187.50
137.50
187.50
150.00
87.50
125.00

Page 17 of 40

APPLICABLE QUARTER
YEAR:

TIONS

2ND
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
187.50
375.00
NE-No Earnings
100.00
112.50
225.00
162.50
112.50
225.00
100.00
175.00
175.00
162.50
150.00
137.50
375.00
100.00
375.00
237.50
137.50
87.50
375.00
125.00
375.00
112.50
250.00
125.00
137.50
125.00
375.00
137.50

Page 18 of 40

APPLICABLE QUARTER
YEAR:

TIONS

2ND
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
100.00
150.00
162.50
87.50
375.00
175.00
150.00
162.50
187.50
125.00
100.00
125.00
100.00
375.00
125.00
375.00
137.50
175.00
187.50
100.00
100.00
175.00
87.50
162.50
137.50
137.50
112.50
112.50
112.50
375.00 NH-Newly Hired
23,200.00

Page 19 of 40

APPLICABLE QUARTER
YEAR:

TIONS

2ND
2011
REMARKS

3RD MONTH
ES

SP-Separated, NE- No Earnings

NH-Newly Hired

Page 20 of 40

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
ADRIANO
EDUARDO
AGUDO
EVELYN
AQUINO
WILLIAM
BADE
BONIFACIO
BAUTISTA
ROMNICK PAOLO
BEQUIZO
EDITHA
BONDOC
LEILANI
BRAVO
MARIE PEACHY
BRILLANTES
JUANITA
BUAN
FELICITAS
BUTUHAN
CIRIACO
CALDERON
GERARDO
CASTRO
RONNEL
CAUILAN
GIRLIE
CENTENO
ROLANDO
CONCEPCION
HENRY
CORPUZ
RODOLFO
CORREA
FILIPINAS
CORREA
TERESITA
CRUZ
IVETTE
CRUZ
LUZVIMINDA
CUSTODIO
RODRIGO
DANIEL
RAMEL
DE JESUS
PAG-ASA
DELA CRUZ
JOSIE
DELA CRUZ
MA. CECILIA
DELA PAZ
FLORENCIA
DELA PAZ
NERIZA
DELOS REYES
CHRISTOPHER
DIMLA
MA. VICTORIA
DIZON
NIMFA
ENRIQUEZ
JULFA
ESPIRITU
PURIFICACION

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
P
DG
S
M
S
E
C
DG
H
B
R
C
P
S
DL
Q
H
M
R
Y
O
V
DB
T
E
SR
V
S
V
V
C
V
M

PIN/SSS
1ST 2ND 3RD
190001406942
8
8
8
190001403692 27 27 27
190001410486
5
5
5
190001401010 27 27 27
072007523530
6
6
6
190001410729 16 16 16
190001408635 27 27 27
070001227481
7
7
7
190001408848
7
7
7
190001408317 27 27 27
190001406691
5
5
5
070000713196
5
5
5
210000061128 12 12 12
190001407655
8
8
8
210000071646 27 27 27
190001408570 27 27 27
190001408694
9
9
9
190001408589
9
9
9
190001400170
8
8
8
190001411407 12 12 12
190001411938 12 12 12
070000542855 27 27 27
190001399768 27 27 27
190001409194 27 27
0
190001408767 15 15 15
070000167744 12 12 12
070000779782 11 11 11
190001410818 15 15 15
070000832861
5
5
5
072003142206
4
4
4
190001409496
7
7
7
190001404788
8
8
8
Page 21 of
190001405687
8 40 8
8

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
237.50
237.50
237.50
237.50
237.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
225.00
225.00
225.00
225.00
225.00
187.50
187.50
187.50
187.50
187.50
175.00
175.00
175.00
175.00
175.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
ESTRELLA
RHEA
EUSEBIO
ILDEFONSA
EVANGELISTA
JOHN CARLO
EVANGELISTA
MARISSA
FRANCISCO
ZENAIDA
GALVEZ
ALEXANDER
GALVEZ
MERCEDITA
GARDOSE
CENONA
GATCHALIAN
ANGELITA
GIANAN
DOMINGO
GIMENO
LOLITA
GIPA
MA. MARIZA
GONZALES
ALEXANDER
GUANSING
AILE
GUILLERMO
ROBERTO
ILETO
GRACIELA
ILLESCAS
RENE ANTHONY
ILUSTRISIMO
NILDA
INDUCIL
EDELMIRA
JOSE
BENILDA
JOSON
REYNANTE
LABANAN
DONATILIA
LEGASPI
MYRNA
LLAMADO
LORELIE
LLAMADO
MA. CARIDAD
MALIWAT
HECTOR
MANAHAN
SILVERIO
MANANGUIT
ELIZABETH
MANIO
ARNOLD
MARCOSO
EDELITA
MENDOZA
ARIEL
MENDOZA
CORAZON
MENDOZA
ESPERANZA

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
G
DG
G
V
P
J
P
E
A
S
V
C
V
A
S
C
B
V
S
O
DC
V
V
N
E
B
V
V
S
B
U
P
P

PIN/SSS
1ST 2ND 3RD
070000765757
5
5
5
190001409402
8
8
8
072011641599
4
4
4
190001411571 12 12 12
190001411156 13 13 13
27 27 27
190001410540 27 27 27
190001409968 10 10 10
190001400359
8
8
8
070000713234
5
5
5
210000040597 10 10 10
190515135875
190002400049 12 12 12
190001403951 26 26 26
190001408945
6
6
6
190001410230
5
5
5
070000779774 11 11 11
190001409704
8
8
8
190001403846 11 19 19
070000167752
6
8
8
190258175798 10 10 10
190001408600
7
7
7
190001410281
5
5
5
190001411512 12 12 12
070000765528
7
7
7
070000765269 15 15 15
190001399334
5
5
5
190001411334 12 12 12
190001409275
8
8
8
190001410915 12 12 12
190001403390
9
9
9
190000321250
4
4
4
190001407949
7
7
7
Page 22 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
100.00
100.00
100.00
100.00
100.00
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
187.50
187.50
187.50
187.50
187.50
200.00
200.00
200.00
200.00
200.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
100.00
100.00
100.00
100.00
100.00
162.50
162.50
162.50
162.50
162.50
187.50
187.50
187.50
187.50
187.50
362.50
362.50
362.50
362.50
362.50
112.50
112.50
112.50
112.50
112.50
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
275.00
275.00
275.00
112.50
112.50
137.50
137.50
137.50
162.50
162.50
162.50
162.50
162.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
137.50
187.50
187.50
187.50
187.50
187.50
150.00
150.00
150.00
150.00
150.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
MIGUEL
PRISCILLA
MIGUEL
ROBERT
PANGILINAN
ADORACION
PASTRANA
ESTELITA
PAULINO
JOANNE
PERUEL
LEONILA
PILE
AGUSTIN
QUIZON
JOSEFINA
REGALA
YOLANDA
REYES
LYDIA
REYES
ROSITA
REYES
ZENAIDA
RIVERA
MA. TERESA
RIVERA
ORLANDO
SALVADOR
GRACE
SALVADOR
RODERICK
SAMANIEGO
BONIFARTE
SANCHEZ
MARILYN
SANCHEZ
MARVIN
SANTIAGO
FERDINAND
SANTIAGO
MARIBETH
SANTOS
LAZARO
SANTOS
PERLA
SARRONDO
LUIS
SAYCO
MARINA
SESE
RICARDO JR
SICAT
LOLITA
STA. ANA
LOLITA
TADEO
SONIA
TAN
PAULA CARLA
TOLENTINO
EMILYN
TORRES
FELIPE

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
S
M
C
P
M
C
I
L
C
T
V
C
N
V
M
S
R
V
I
A
S
E
P
T
V
G
T
F
C
G
L
V

PIN/SSS
1ST 2ND 3RD
190001411660 12 12 12
210000075013 27 27 27
190001401568
5
5
5
070000167914
6
6
6
190001411261 15 15 15
070000167930 10 10 10
190001405903
6
6
6
190001407523 15 15 15
070000167779
190001409577
5
5
5
070000167787 11 11 11
070001227473 11 11 11
070001011462 10 10 10
190001399911
9
9
9
070000632013
8
8
8
070000366744 27 27 27
190001410141
5
5
5
190001404362 27 27 27
190001410702 16 16 16
070001078451
8
8
8
070251467658
4
4
4
210000071883 27 27 27
070000765595
7
7
7
210250408794 27 27 27
070251667894
6
190001410821 17 17 17
070000631998
7
7
7
190001409836
8
8
8
190001408457
7
7
7
27 27 27
070000765404
8
8
8
190001406624
5
5
5
Page 23 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
162.50
162.50
162.50
162.50
162.50
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
NE-No Earnings
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
162.50
162.50
162.50
162.50
162.50
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
237.50
237.50
237.50
237.50
237.50
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
112.50
112.50
250.00
250.00
250.00
250.00
250.00
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50
100.00
100.00
100.00
100.00
100.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
VALMADRID
ELIZABETH
VALMADRID
ILDEFONSO
VALMADRID
ISAIAS JR
VALMADRID
ROEL
VANGUARDIA
ESTRELL
VASALLO
WILMA
VELILLA
ANTHONY
VENDIVIL
ANICIA
VENDIVIL
ANTONINA
VERDIDO
EDILBERTO
VICTORIA
EDELUISA
VICTORIA
JAIME
VICTORIO
SHERWIN
VILLACORTE
ANABELLE
VILLACORTE
ENRIQUE
VILLANUEVA
BIBIAN
VILLANUEVA
DESIREE
VILLANUEVA
MA. TERESA
VIOLAGO
NUMERIANO
ZURBITO
SAMSON
TIANGCO
MA. LOURDES
CRUZ
ALVIN
ESPIRITU
MARVIN DALE
SAMSON
RENITA
SANTOS
REY
VALMADRID
CORAZON
SANTOS
FRANCIS EDWARD
CRUZ
ROMINA
REYES
MARK LESTER
CASTRO
MARK JOSEPH
DIMAFELIX
JERALYN
TIONGSON
SHALIMAR

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
T
M
V
M
F
S
DG
P
P
V
R
S
V
B
C
B
C
V
M
A
C
V
B
T
E
V
N
O
P
P
G
N

PIN/SSS
1ST 2ND 3RD
190001398958
9
9
9
072008918989 10 10 10
070250741381
4
4
4
27 27 27
070000167795 11 11 11
190001400502
9
9
9
190258175998 10 10 10
190001411016 12 12 12
190001399199
7
7
7
190001406373
5
5
5
190001407760
7
7
7
190001405245
5
5
5
070001057497 27 27 27
190001409372
7
7
7
210000044991 27 27 27
190001402211
8
8
8
072003121519 11 11 11
190001400618 12 12 12
190001410435
5
5
5
190001402769
5
5
5
190506244890 11 11 11
4 11 11
10 10 10
007025290753
8
8
8
212000202441
8
8
8
6
6
6
210250313718
6
6
6
6
6
6
27 27 27
6
6
6
6
6
6
Page 24 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00
175.00
175.00
175.00
175.00
175.00
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
175.00
175.00
175.00
187.50
187.50
187.50
187.50
187.50
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
87.50
87.50
175.00
175.00
175.00
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

Action taken:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

131
132
133

USE

Date Received:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
CUNANAN
JOEL
ALBERTO
ROWELL
GIPA
MARIELLA

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
R
S
C

PIN/SSS
080506891292

1ST 2ND 3RD

4
8

4
8
6

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

2ND MONTH
3RD MONTH
PS
ES
PS
87.50
87.50
87.50
137.50
137.50
137.50
137.50
112.50
23,212.50 23,737.50 23,737.50 23,475.00

1ST MONTH
PS
ES
137.50
23,212.50

TOTAL

GOVERNMENT
REGULAR RF1

CERTIFIED CORRECT :
ARIEL U. MENDOZA
H.R.M.O. IV

Page 25 of 40

APPLICABLE QUARTER
YEAR:

TIONS

3RD
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
137.50
375.00
100.00
375.00
112.50
237.50
375.00
125.00
125.00
375.00
100.00
100.00
187.50
137.50
375.00
375.00
150.00
150.00
137.50
187.50
187.50
375.00
375.00
NO-No Earnings
225.00
187.50
175.00
225.00
100.00
87.50
125.00
137.50
137.50

Page 26 of 40

APPLICABLE QUARTER
YEAR:

TIONS

3RD
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
100.00
137.50
87.50
187.50
200.00
375.00
375.00
162.50
137.50
100.00
162.50
NO-No Earnings
187.50
362.50
112.50
100.00
175.00
137.50
275.00
137.50
162.50
125.00
100.00
187.50
125.00
225.00
100.00
187.50
137.50
187.50
150.00
87.50
125.00

Page 27 of 40

APPLICABLE QUARTER
YEAR:

TIONS

3RD
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
187.50
375.00
100.00
112.50
225.00
162.50
112.50
225.00
NE-No Earnings
100.00
175.00
175.00
162.50
150.00
137.50
375.00
100.00
375.00
237.50
137.50
87.50
375.00
125.00
375.00
NO-No Earnings
250.00
125.00
137.50
125.00
375.00
137.50
100.00

Page 28 of 40

APPLICABLE QUARTER
YEAR:

TIONS

3RD
2011
REMARKS

3RD MONTH
ES
150.00
162.50
87.50
375.00
175.00
150.00
162.50
187.50
125.00
100.00
125.00
100.00
375.00
125.00
375.00
137.50
175.00
187.50
100.00
100.00
175.00
175.00
162.50
137.50
137.50
112.50
112.50
112.50
375.00
112.50
112.50
112.50

SP-Separated, NE- No Earnings

NH-Newly Hired

NH-Newly Hired
NH-Newly Hired
NH-Newly Hired

Page 29 of 40

APPLICABLE QUARTER
YEAR:

TIONS

3RD
2011
REMARKS

3RD MONTH
ES
87.50
137.50
112.50
23,475.00

SP-Separated, NE- No Earnings

NH-Newly Hired
NH-Newly Hired
NH-Newly Hired
NH-Newly Hired

Page 30 of 40

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
ADRIANO
EDUARDO
AGUDO
EVELYN
AQUINO
WILLIAM
BADE
BONIFACIO
BAUTISTA
ROMNICK PAOLO
BEQUIZO
EDITHA
BONDOC
LEILANI
BRAVO
MARIE PEACHY
BRILLANTES
JUANITA
BUAN
FELICITAS
BUTUHAN
CIRIACO
CALDERON
GERARDO
CASTRO
RONNEL
CAUILAN
GIRLIE
CENTENO
ROLANDO
CONCEPCION
HENRY
CORPUZ
RODOLFO
CORREA
FILIPINAS
CORREA
TERESITA
CRUZ
IVETTE
CRUZ
LUZVIMINDA
CUSTODIO
RODRIGO
DANIEL
RAMEL
DELA CRUZ
JOSIE
DELA CRUZ
MA. CECILIA
DELA PAZ
FLORENCIA
DELA PAZ
NERIZA
DELOS REYES
CHRISTOPHER
DIMLA
MA. VICTORIA
DIZON
NIMFA
ENRIQUEZ
JULFA
ESPIRITU
PURIFICACION
ESTRELLA
RHEA

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
P
DG
S
M
S
E
C
DG
H
B
R
C
P
S
DL
Q
H
M
R
Y
O
V
DB
E
SR
V
S
V
V
C
V
M
G

PIN/SSS
1ST 2ND 3RD
190001406942
8
8
8
190001403692 27 27 27
190001410486
5
5
5
190001401010 27 27 27
072007523530
6
6
6
190001410729 16 16 16
190001408635 27 27 27
070001227481
7
7
7
190001408848
7
7
7
190001408317 27 27 27
190001406691
5
5
5
070000713196
5
5
5
210000061128 12 12 12
190001407655
8
8
8
210000071646 27 27 27
190001408570 27 27 27
190001408694
9
9
9
190001408589
9
9
9
190001400170
8
8
8
190001411407 12 12 12
190001411938 12 12 12
070000542855 27 27 27
190001399768 27 27 27
190001408767 15 15 15
070000167744 12 12 12
070000779782 11 11 11
190001410818 15 15 15
070000832861
5
5
5
072003142206
4
4
4
190001409496
7
7
7
190001404788
8
8
8
190001405687
8
8
8
070000765757
Page 31 of
5 40 5
5

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
237.50
237.50
237.50
237.50
237.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
225.00
225.00
225.00
225.00
225.00
187.50
187.50
187.50
187.50
187.50
175.00
175.00
175.00
175.00
175.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
100.00
100.00
100.00
100.00
100.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
EUSEBIO
ILDEFONSA
EVANGELISTA
JOHN CARLO
EVANGELISTA
MARISSA
FRANCISCO
ZENAIDA
GALVEZ
ALEXANDER
GALVEZ
MERCEDITA
GARDOSE
CENONA
GATCHALIAN
ANGELITA
GIANAN
DOMINGO
GIMENO
LOLITA
GONZALES
ALEXANDER
GUANSING
AILE
GUILLERMO
ROBERTO
ILETO
GRACIELA
ILLESCAS
RENE ANTHONY
ILUSTRISIMO
NILDA
INDUCIL
EDELMIRA
JOSE
BENILDA
JOSON
REYNANTE
LABANAN
DONATILIA
LEGASPI
MYRNA
LLAMADO
LORELIE
LLAMADO
MA. CARIDAD
MALIWAT
HECTOR
MANAHAN
SILVERIO
MANANGUIT
ELIZABETH
MANIO
ARNOLD
MARCOSO
EDELITA
MENDOZA
ARIEL
MENDOZA
CORAZON
MENDOZA
ESPERANZA
MIGUEL
PRISCILLA
MIGUEL
ROBERT

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
DG
G
V
P
J
P
E
A
S
V
V
A
S
C
B
V
S
O
DC
V
V
N
E
B
V
V
S
B
U
P
P
S
M

PIN/SSS
1ST 2ND 3RD
190001409402
8
8
8
072011641599
4
4
4
190001411571 12 12 12
190001411156 13 13 13
27 27 27
190001410540 27 27 27
190001409968 10 10 10
190001400359
8
8
8
070000713234
5
5
5
210000040597 10 10 10
190002400049 12 12 12
190001403951 26 26 26
190001408945
6
6
6
190001410230
5
5
5
070000779774 11 11 11
190001409704
8
8
8
190001403846 11 19 19
070000167752
6
8
8
190258175798 10 10 10
190001408600
7
7
7
190001410281
5
5
5
190001411512 12 12 12
070000765528
7
7
7
070000765269 15 15 15
190001399334
5
5
5
190001411334 12 12 12
190001409275
8
8
9
190001410915 12 12 12
190001403390
9
9
9
190000321250
4
4
4
190001407949
7
7
7
190001411660 12 12 12
210000075013
Page 3227
of 4027 27

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
187.50
187.50
187.50
187.50
187.50
200.00
200.00
200.00
200.00
200.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
375.00
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
100.00
100.00
100.00
100.00
100.00
162.50
162.50
162.50
162.50
162.50
187.50
187.50
187.50
187.50
187.50
362.50
362.50
362.50
362.50
362.50
112.50
112.50
112.50
112.50
112.50
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
275.00
275.00
275.00
112.50
112.50
137.50
137.50
137.50
162.50
162.50
162.50
162.50
162.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
187.50
187.50
187.50
187.50
187.50
137.50
137.50
137.50
137.50
150.00
187.50
187.50
187.50
187.50
187.50
150.00
150.00
150.00
150.00
150.00
87.50
87.50
87.50
87.50
87.50
125.00
125.00
125.00
125.00
125.00
187.50
187.50
187.50
187.50
187.50
375.00
375.00
375.00
375.00
375.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
PANGILINAN
ADORACION
PASTRANA
ESTELITA
PAULINO
JOANNE
PERUEL
LEONILA
PILE
AGUSTIN
QUIZON
JOSEFINA
REYES
LYDIA
REYES
ROSITA
REYES
ZENAIDA
RIVERA
MA. TERESA
RIVERA
ORLANDO
SALVADOR
GRACE
SALVADOR
RODERICK
SAMANIEGO
BONIFARTE
SANCHEZ
MARILYN
SANCHEZ
MARVIN
SANTIAGO
FERDINAND
SANTIAGO
MARIBETH
SANTOS
LAZARO
SANTOS
PERLA
SARRONDO
LUIS
SESE
RICARDO JR
SICAT
LOLITA
STA. ANA
LOLITA
TADEO
SONIA
TAN
PAULA CARLA
TOLENTINO
EMILYN
TORRES
FELIPE
VALMADRID
ELIZABETH
VALMADRID
ILDEFONSO
VALMADRID
ISAIAS JR
VALMADRID
ROEL

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
C
P
M
C
I
L
T
V
C
N
V
M
S
R
V
I
A
S
E
P
T
G
T
F
C
G
L
V
T
M
V
M

PIN/SSS
1ST 2ND 3RD
190001401568
5
5
5
070000167914
6
6
6
190001411261 15 15 15
070000167930 10 10 10
190001405903
6
6
6
190001407523 15 15 15
190001409577
5
5
5
070000167787 11 11 11
070001227473 11 11 11
070001011462 10 10 10
190001399911
9
9
9
070000632013
8
8
8
070000366744 27 27 27
190001410141
5
5
5
190001404362 27 27 27
190001410702 16 16 16
070001078451
8
8
8
070251467658
4
4
4
210000071883 27 27 27
070000765595
7
7
7
210250408794 27 27 27
190001410821 17 17 17
070000631998
7
7
7
190001409836
8
8
8
190001408457
7
7
7
27 27 27
070000765404
8
8
8
190001406624
5
5
5
190001398958
9
9
9
072008918989 10 10 10
070250741381
4
4
4
27 27 27
Page 33 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
100.00
100.00
100.00
100.00
100.00
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
162.50
162.50
162.50
162.50
162.50
112.50
112.50
112.50
112.50
112.50
225.00
225.00
225.00
225.00
225.00
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
175.00
162.50
162.50
162.50
162.50
162.50
150.00
150.00
150.00
150.00
150.00
137.50
137.50
137.50
137.50
137.50
375.00
375.00
375.00
375.00
375.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
237.50
237.50
237.50
237.50
237.50
137.50
137.50
137.50
137.50
137.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
250.00
250.00
250.00
250.00
250.00
125.00
125.00
125.00
125.00
125.00
137.50
137.50
137.50
137.50
137.50
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50
100.00
100.00
100.00
100.00
100.00
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
87.50
87.50
87.50
87.50
87.50
375.00
375.00
375.00
375.00
375.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

USE

Date Received:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130

Action taken:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
VANGUARDIA
ESTRELL
VASALLO
WILMA
VELILLA
ANTHONY
VENDIVIL
ANICIA
VENDIVIL
ANTONINA
VERDIDO
EDILBERTO
VICTORIA
EDELUISA
VICTORIA
JAIME
VICTORIO
SHERWIN
VILLACORTE
ANABELLE
VILLACORTE
ENRIQUE
VILLANUEVA
BIBIAN
VILLANUEVA
DESIREE
VILLANUEVA
MA. TERESA
VIOLAGO
NUMERIANO
ZURBITO
SAMSON
TIANGCO
MA. LOURDES
CRUZ
ALVIN
ESPIRITU
MARVIN DALE
SAMSON
RENITA
SANTOS
REY
VALMADRID
CORAZON
SANTOS
FRANCIS EDWARD
CRUZ
ROMINA
REYES
MARK LESTER
CASTRO
MARK JOSEPH
DIMAFELIX
JERALYN
TIONGSON
SHALIMAR
CUNANAN
JOEL
ALBERTO
ROWELL
GIPA
MARIELLA
ALDABA
KRISTINE ROSE

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI
F
S
DG
P
P
V
R
S
V
B
C
B
C
V
M
A
C
V
B
T
E
V
N
O
P
P
G
N
R
S
C
B

PIN/SSS
1ST 2ND 3RD
070000167795 11 11 11
190001400502
9
9
9
190258175998 10 10 10
190001411016 12 12 12
190001399199
7
7
7
190001406373
5
5
5
190001407760
7
7
7
190001405245
5
5
5
070001057497 27 27 27
190001409372
7
7
7
210000044991 27 27 27
190001402211
8
8
8
072003121519 11 11 11
190001400618 12 12 12
190001410435
5
5
5
190001402769
5
5
5
190506244890 11 11 11
010505862630
4 11 11
010502908087 10 10 10
007025290753
8
8
8
212000202441
8
8
8
007010001195
6
6
6
210250313718
6
6
6
210000109848
6
6
6
27 27 27
072011641475
6
6
6
072011641261
6
6
6
212000331489
6
6
6
072007482427
4
4
4
080506891292
8
8
8
6
6
6
11 11 11
Page 34 of 40

GOVERNMENT
REGULAR RF1

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

1ST MONTH
2ND MONTH
3RD MONTH
PS
ES
PS
ES
PS
175.00
175.00
175.00
175.00
175.00
150.00
150.00
150.00
150.00
150.00
162.50
162.50
162.50
162.50
162.50
187.50
187.50
187.50
187.50
187.50
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
125.00
125.00
125.00
125.00
125.00
100.00
100.00
100.00
100.00
100.00
375.00
375.00
375.00
375.00
375.00
125.00
125.00
125.00
125.00
125.00
375.00
375.00
375.00
375.00
375.00
137.50
137.50
137.50
137.50
137.50
175.00
175.00
175.00
175.00
175.00
187.50
187.50
187.50
187.50
187.50
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
175.00
175.00
175.00
175.00
175.00
87.50
87.50
175.00
175.00
175.00
162.50
162.50
162.50
162.50
162.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
137.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
375.00
375.00
375.00
375.00
375.00
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
112.50
87.50
87.50
87.50
87.50
87.50
137.50
137.50
137.50
137.50
137.50
112.50
112.50
112.50
112.50
112.50
175.00
175.00
175.00
175.00
175.00

RF1
PHILHEALTH NO.
EMPLOYER TIN
EMPLOYER SSS

EMPLOYER'S
QUARTERLY
REMITTANCE
REPORT

FOR PHILHEALTH
Date Screened:

Action taken:

By:

By:

Signature over Printed Name

Signature Over Printed Name

151914000001
004545538000

EMPLOYER NAME
: MUNICIPALITY OF SAN ILDEFONSO
MAILING ADDRESS : POBLACION, SAN ILDEFONSO, BULACAN
Tel. No.
: 677-05-48

131
132

USE

Date Received:

NAME OF EMPLOYEES
SURNAME
GIVEN NAME
BAUTISTA
RUBIKA
GARCIA
MICHELLE

EMPLOYER TYPE: G
TYPE OF REPORT: R
BRACKET
MONTHLY

MI

PIN/SSS

1ST 2ND 3RD

G
S

APPLICABLE QUARTER

NHIP PREMIUM CONTRIBUTIONS

2ND MONTH
3RD MONTH
PS
ES
PS
137.50
162.50
23,437.50 23,650.00 23,650.00 23,962.50

1ST MONTH
PS
ES

8
10
23,437.50

TOTAL

GOVERNMENT
REGULAR RF1

CERTIFIED CORRECT :
ARIEL U. MENDOZA
H.R.M.O. IV

Page 35 of 40

APPLICABLE QUARTER
YEAR:

TIONS

4TH
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
137.50
375.00
100.00
375.00
112.50
237.50
375.00
125.00
125.00
375.00
100.00
100.00
187.50
137.50
375.00
375.00
150.00
150.00
137.50
187.50
187.50
375.00
375.00
225.00
187.50
175.00
225.00
100.00
87.50
125.00
137.50
137.50
100.00

Page 36 of 40

APPLICABLE QUARTER
YEAR:

TIONS

4TH
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
137.50
87.50
187.50
200.00
375.00
375.00
162.50
137.50
100.00
162.50
187.50
362.50
112.50
100.00
175.00
137.50
275.00
137.50
162.50
125.00
100.00
187.50
125.00
225.00
100.00
187.50
150.00
187.50
150.00
87.50
125.00
187.50
375.00

Page 37 of 40

APPLICABLE QUARTER
YEAR:

TIONS

4TH
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
100.00
112.50
225.00
162.50
112.50
225.00
100.00
175.00
175.00
162.50
150.00
137.50
375.00
100.00
375.00
237.50
137.50
87.50
375.00
125.00
375.00
250.00
125.00
137.50
125.00
375.00
137.50
100.00
150.00
162.50
87.50
375.00

Page 38 of 40

APPLICABLE QUARTER
YEAR:

TIONS

4TH
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
175.00
150.00
162.50
187.50
125.00
100.00
125.00
100.00
375.00
125.00
375.00
137.50
175.00
187.50
100.00
100.00
175.00
175.00
162.50
137.50
137.50
112.50
112.50
112.50
375.00
112.50
112.50
112.50
87.50
137.50
112.50
175.00 NH-Newly Hired

Page 39 of 40

APPLICABLE QUARTER
YEAR:

TIONS

4TH
2011

REMARKS
3RD MONTH
SP-Separated, NE- No Earnings
ES
NH-Newly Hired
137.50 NH-Newly Hired
162.50 NH-Newly Hired
23,962.50

Page 40 of 40