Republic of the Philippines

R-1A SOCIAL SECURITY SYSTEM

REV. 01 - 2001 EMPLOYMENT REPORT
(Please read instructions/reminders at the back. Print all information in black ink.)
EMPLOYER ID NUMBER REGISTERED EMPLOYER NAME TAXPAYER IDENTIFICATION NO.
8 0 0 0 1 0 3 6 6 6 D COLDMAN AIRCON SERVICES 212-332-518
ADDRESS POSTAL CODE
782 QUIRINO AVENUE, BRGY. TAMBO, PARAÑAQUE CITY 1 7 0 1
Name of Employee Date of Birth Date of Employment Remarks
SS Number Position Monthly Salary
(Surname) (Given Name) (MI) ( MMDDYYYY ) ( MMDDYYYY ) FOR SSS USE

0 2 3 5 2 0 9 8 7 0 1. CULALA EDWIN H. PRODUCTION STAFF 1 0 0 0 0 0 7 2 5 2 0 1 9

3 4 8 7 1 2 7 9 3 0 2. DE VELA JAKE V. PRODUCTION STAFF 1 0 0 0 0 0 7 2 5 2 0 1 9
3 4 7 0 5 0 7 8 8 4 3. GONZALES JEFFREI A. PRODUCTION STAFF 1 0 0 0 0 0 8 1 2 2 0 1 9
0 2 3 7 5 9 1 2 3 0 4. GUERRERO EMIAJ JAMES PRODUCTION STAFF 1 0 0 0 0 0 7 1 5 2 0 1 9
3 4 8 7 1 5 1 1 9 7 5. MERCADO LINEUS L. PRODUCTION STAFF 1 0 0 0 0 0 7 1 5 2 0 1 9
0 5 0 6 2 2 7 5 0 7 6. RAFER JAZPHER V. PRODUCTION STAFF 1 0 0 0 0 0 8 0 5 2 0 1 9
3 4 7 8 4 8 2 7 5 2 7. VEGA JAHN DENVER R. PRODUCTION STAFF 1 0 0 0 0 0 7 2 5 2 0 1 9
3 4 8 7 0 9 9 9 0 3 8. VIBAR RANDY D. PRODUCTION STAFF 1 0 0 0 0 0 7 3 0 2 0 1 9
3 3 3 9 5 1 1 8 5 6 9. ZAMUDIO REYNALDO B. ADMIN OFFICER 1 2 0 0 0 0 7 3 0 2 0 1 9
10. =0= NOTHING FOLLOOWS =0=
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TOTAL NO. OF CERTIFIED CORRECT : FOR SSS USE RECEIVED BY/DATE:

REPORTED ADOLFO R. DE VELA PROCESSED BY/DATE: REVIEWED BY/DATE: ENCODED BY/DATE:
9
EMPLOYEES Signature Over Printed Name
of Authorized Signatory
1 of ___
Page ___ 1 Page/s GEN. MANAGER
Official Designation Date Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
 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 a 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.