PAYOR's COPY

Republic of the Philippines

SOCIAL SECURITY SYSTEM
ELECTRONIC CONTRIBUTION
CON -
COLLECTION LIST SUMMARY

02-0989731-5-000
ALPHAMED MEDICAL GROUP INC
CITICORP BUS CTR SAN ISIDRO CITY OF SAN FERNANDO
PAMPANGA
2000 This is your official receipt when validated

Payment Reference Number

Due Date : January 04, 2021 5L200167363787
Generation Date : December 02, 2020

Electronic Contribution Collection List Summary for the Applicable Month of November 2020
Total Number of Employees : 30
Breakdown of Contributions :
Social Security (SS) Php 42,300.00
Employee Compensation (EC) 380.00
Total Amount Due Php 42,680.00

Please pay on or before the due date at any SSS accredited collecting partner/bank or SSS Branch with Tellering Facility. A penalty of 2% per
month, pursuant to Section 22(a) of RA No. 11199 (Social Security Act of 2018), shall be imposed on contributions not paid within the prescribed
schedule.

The SSS reserves the right to determine and collect the true and correct contributions due the SSS if it finds other un-remitted/underpaid/out-of-
bracket contributions during or before the period billed. SSS shall conduct further verification and assessment on the details of the Electronic
Contribution Collection List (e-CCL) and shall collect any balance, if any.

For inquiries, please email PRNHelpline@sss.gov.ph. You may contact us at 8-920-6446 or 7-917-7777.

This is a system-generated summary, signature is not needed.

SSS' COPY
Republic of the Philippines
SOCIAL SECURITY SYSTEM
ELECTRONIC CONTRIBUTION
COLLECTION LIST SUMMARY
CON -
PAYMENT SLIP

02-0989731-5-000
ALPHAMED MEDICAL GROUP INC
November 2020

Payment Reference Number

5L200167363787
 Republic of the Philippines
SOCIAL SECURITY SYSTEM
ELECTRONIC CONTRIBUTION
CON -
COLLECTION LIST

Payment Reference Number

02-0989731-5-000 5L200167363787
ALPHAMED MEDICAL GROUP INC
November 2020

Name of Employee SS Number SS EC Total Contributions

1 AGAO, LAURA C 02-3720773-1 1,080.00 10.00 1,090.00
2 BUCAY, CHERYL B 02-2733101-5 1,560.00 10.00 1,570.00
3 BULACAN, FRANCISCO S 33-6534598-6 1,080.00 10.00 1,090.00
4 CERVERA, MA RICHIE MAE T 04-2625992-7 1,140.00 10.00 1,150.00
5 CONSIGNA, VERNALENE A 02-4640884-8 1,440.00 10.00 1,450.00
6 CUNANAN, JESSICA M 34-8192120-0 1,200.00 10.00 1,210.00
7 DEANG, JULIE ANNE M 34-0863015-0 1,800.00 30.00 1,830.00
8 DEANG, KENNETH Q 02-2830990-7 1,080.00 10.00 1,090.00
9 DEL PILAR, SHEENA RITA S 02-2423617-1 1,800.00 30.00 1,830.00
10 DEL ROSARIO, JOANNA M 02-2672428-3 1,440.00 10.00 1,450.00
11 DIMACALI, BON JOVI G 02-3129276-8 1,080.00 10.00 1,090.00
12 ESGUERRA, JOHN PAULO V 34-8110538-5 1,680.00 10.00 1,690.00
13 GARCIA, MERRY CHRIST C 02-2835914-8 1,320.00 10.00 1,330.00
14 GOMEZ, LOVELY ANISSA B 02-2941313-5 1,260.00 10.00 1,270.00
15 GUEVARRA, MARJORIE L 34-0173345-2 1,140.00 10.00 1,150.00
16 IGNACIO, AILEEN C 34-1206103-2 1,440.00 10.00 1,450.00
17 INGAL, ANGELICA H 34-5849905-3 1,680.00 10.00 1,690.00
18 KONEKO, ERIKA A 02-4613565-8 1,440.00 10.00 1,450.00
19 MANIO, EVELYN B 02-1441774-8 1,080.00 10.00 1,090.00
20 MONTEMAYOR, REINA M 33-7866372-3 1,440.00 10.00 1,450.00
21 NUÑEZ, LADY GABRIELLE N 34-8237933-0 1,440.00 10.00 1,450.00
22 PANLAQUI, ELMER D 02-4266573-7 1,080.00 10.00 1,090.00
23 QUIAMBAO, JIZZAFEE M 34-9016411-3 1,440.00 10.00 1,450.00
24 SANTOS, CAMILLE D 02-3551479-8 1,680.00 10.00 1,690.00
25 SILVA, TIFFANY C 02-2938765-6 1,440.00 10.00 1,450.00
26 SORIANO, CHARMAINE T 02-3577230-7 1,920.00 30.00 1,950.00
27 TEVES, DANIEL N 08-1782670-7 1,080.00 10.00 1,090.00
28 TIGLAO, ADRIAN C 34-8954976-5 1,680.00 10.00 1,690.00
29 TRINIDAD, NOEMI T 02-1766941-2 1,440.00 10.00 1,450.00
30 VALENCIA, AURORA F 33-3120584-3 1,920.00 30.00 1,950.00
Sub-total Php 42,300.00 Php 380.00 Php 42,680.00
Total Amount Due Php 42,680.00

This is a system-generated list, signature is not needed. Page 1 of 1