EMPLOYEES INFORMATION

* encode information starting at cell A6

GENERAL INFORMATION SSS CONTRIBUTION DETAILS
SSS TOTAL EMPLOYER & SSS EMPLOYEE
FIRST NAME LAST NAME MIDDLE NAME DATE HIRED/SEPARATED OR EFFECTIVITY SSS NUMBER
EMPLOYEES CONTRIBUTION COMPENSATION PREMIUM
REQUIRED REQUIRED REQUIRED REQUIRED (SSS ONLY) REQUIRED REQUIRED REQUIRED
JERRY VIEM EDISAN BARAQUIA
SHERO JOHN MACEDA GOMOS
RAYMON MANDAWE FORTUN
ALI METANTE PEVIDA
ROMELYN MORILLO MIANO
JOVANIE NARAJA CATARAJA
BEATRIZ PAQUIBO ALBURO
MYLENE LEQUIGAN POTOT
JOEY SARSALEJO TEROL
SHIELA SOLLANO UMPAD
ROBERT UMPAD ANDRINO
ANE YPIL PIANAR
CAROLYN YPIL PAGOBO
NINO JOEY QUIMBO CANOY
SAYSON ROMELITO GILA
JASPHER ONG AGUDO
IBUTION DETAILS SSS LOAN DETAILS
SSS MEDICARE SSS EMPLOYMENT SSS EMPLOYMENT MONTHLY
LOAN TYPE LOAN DATE LOAN AMOUNT PENALTY AMPDSG PAG-IBIG ID
CONTRIBUTION STATUS(CONTRIBUTION) STATUS(LOANS) AMORTIZATION
NOT REQUIRED REQUIRED REQUIRED REQUIRED REQUIRED REQUIRED NOT REQUIRED REQUIRED NOT REQUIRED REQUIRED
121191492793
121065940043
121120016681
121191589795
121112163032
121065788007
121066013532
121086211169
121112137766
121082403977
121166642006
121092324179
121095366064
121089722508
121052143007
167001587209
 PAG-IBIG CONTRIBUTION DETAILS PHILHEALTH CONTRIB
PAG-IBIG EMPLOYERS PHILHEALTH
EMPLOYEE ID TIN NUMBER PAG-IBIG MEMBERS CONTRIBUTION SHORT TERM LOAN CALAMITY LOAN BIRTHDATE PHILHEALTH ID
CONTRIBUTION EMPLOYEE STATUS
NOT REQUIRED NOT REQUIRED REQUIRED REQUIRED NOT REQUIRED NOT REQUIRED NOT REQUIRED DO NOT FILL UP - PHILHEALTH FILING IS DONE THROUGH
134.40 134.40 363.89
216.00 240.00 1116.87
165.00 165.00 425.33
140.00 140.00 281.60
165.60 165.60 520.98
165.60 165.60 619.17
216.00 216.00 785.82
148.80 148.80 466.52
136.40 136.40 449.31
158.70 158.70 623.12
145.00 145.00
139.20 139.20 520.07
138.00 138.00 326.44
129.60 129.60
115.00 115.00 293.51
500.00 500.00
 PHILHEALTH CONTRIBUTION DETAILS DBP PAYROLL
PHILHEALTH EMPLOYEES PHILHEALTH
COMPENSATION EMPLOYERS DBP ACCOUNT NUMBER DBP ACCOUNT NAME AMOUNT TO BE CREDITED
CONTRIBUTION
CONTRIBUTION
EALTH FILING IS DONE THROUGH PHILHEALTH's EPRS / PAYMENT STILL WITH EGOV REQUIRED REQUIRED REQUIRED
 EMPLOYEES INFORMATION
* encode information starting at cell A6
GENERAL INFORMATION
FIRST NAME LAST NAME MIDDLE NAME

REQUIRED REQUIRED REQUIRED

GRACE LEE LUX
JOSE TUMAGAN CO
ANDRES HENSON ARCEO
ANTONIO EUSEBIO SANTOS
MARY MISA ABRERA
CARY JOHN ALEJANDRO ABAYA
ADAM PACIS MAAMBONG
JOEY DAVID NAVARRO
PRINCESS RIVERA DEL ROSARIO
MARIA ANNA REYES CRUZ

1) General Information required fields must always be filled regardless of payment type
2) Other information required are dependent on the payment type (color coded)
Example:
You only need to fill the required fields under General Information (blue) and Pag-ibig
contribution details (purple), if eGOV will be used for Pag-ibig payments only.

3) Format (text, number, general) must not be changed

MATION SSS CONTRIBUTION
SSS TOTAL EMPLOYER &
DATE HIRED/SEPARATED OR EFFECTIVITY SSS NUMBER
EMPLOYEES CONTRIBUTION
REQUIRED (SSS AND PHILHEALTH ONLY) REQUIRED REQUIRED
6/12/2008 3314304501 1,595.00
2/16/2009 0378719202 605.00
3/18/2008 0121165953 660.00
6/3/2002 0386815094 715.00
3/16/1999 3364026625 770.00
6/3/2002 0391572727 825.00
9/20/1999 3377582208 1,650.00
10/11987 3315881309 1,705.00
6/19/1976 3436687930 1,760.00
3/18/2008 3336250072 1,760.00

Format must be NU
is applicable to oth
s of payment type require an amount
olor coded)

Format must be DATE. This is Format must be TEXT and no

ue) and Pag-ibig true with the other fields that Dashes. This is true with the other
require date entries IDs and account number fields
 SSS CONTRIBUTION DETAILS
SSS EMPLOYEE SSS MEDICARE SSS EMPLOYMENT
COMPENSATION PREMIUM CONTRIBUTION STATUS(CONTRIBUTION)
REQUIRED REQUIRED
10.00 Normal
10.00 Normal
10.00 Normal
10.00 Normal
10.00 Normal
10.00 Normal
30.00 Normal
30.00 Normal
30.00 Normal
30.00 Normal

Format must be NUMBER. This

is applicable to other fileds that
require an amount
 SSS LOAN DETAILS
SSS EMPLOYMENT
LOAN TYPE LOAN DATE LOAN AMOUNT PENALTY
STATUS(LOANS)
REQUIRED REQUIRED REQUIRED REQUIRED
Salary Loan 2/23/2016 Hired 11,000.00
Calamity Loan 9/3/2015 Hired 25,000.00
Salary Loan 2/23/2016 Hired 5,000.00
Calamity Loan 6/11/2015 Hired 11,000.00
Salary Loan 2/1/2016 Hired 11,000.00
Calamity Loan 1/7/2015 Hired 11,000.00
Salary Loan 7/23/2014 Hired 11,000.00
Salary Loan 6/5/2015 Hired 6,000.00
Salary Loan 8/22/2014 Hired 11,000.00
Salary Loan 11/23/2015 Hired 22,000.00
 P
MONTHLY
AMPDSG PAG-IBIG ID EMPLOYEE ID
AMORTIZATION
REQUIRED REQUIRED
040280659601 103
040286442202 43
040277130903 60
040245998304 68
040243349205 162
040245998616 51
040243349407 86
040217403808 145
040280659809 99
040280659900 113
 PAG-IBIG CONTRIBUTION DETAILS
PAG-IBIG EMPLOYERS
TIN NUMBER PAG-IBIG MEMBERS CONTRIBUTION
CONTRIBUTION
REQUIRED REQUIRED
2494161510001 100.00 100.00
2683259860002 100.00 100.00
2344273680003 100.00 100.00
1753615750004 100.00 100.00
9170159990005 100.00 100.00
2227091660006 100.00 100.00
2224052290007 100.00 100.00
1123568770008 100.00 100.00
2660854760009 100.00 100.00
2660854760010 100.00 100.00
 PHILHEALTH CONTRIBU
PHILHEALTH
SHORT TERM LOAN CALAMITY LOAN BIRTHDATE PHILHEALTH ID
EMPLOYEE STATUS
REQUIRED REQUIRED
1040.47 190896680481 REGULAR
882.41 020502292032 REGULAR
1096.43 050253901593 REGULAR
020504154694 REGULAR
190893556755 REGULAR
2261.49 322.43 190504813926 REGULAR
1998.60 190895720587 REGULAR
3143.01 020502292018 REGULAR
030254935009 REGULAR
030254935009 REGULAR
 *the eGOV converter may also generate the D

PHILHEALTH CONTRIBUTION DETAILS DBP PAYRO

PHILHEALTH
PHILHEALTH EMPLOYEES
COMPENSATION EMPLOYERS DBP ACCOUNT NUMBER
CONTRIBUTION
CONTRIBUTION
REQUIRED REQUIRED REQUIRED
5,700.00 100.00 100.00 888021365412
162.50 162.50 758021365413
5,000.00 100.00 100.00 090021365401
100.00 100.00 000021365000
3,000.00 100.00 100.00 123021365419
16,000.00 200.00 200.00 500021365413
0.00 0.00 128921365412
13,000.00 162.50 162.50 993021365413
100.00 100.00 883021365412
12,500.00 150.00 150.00 266085476001
verter may also generate the DBP Payroll file

DBP PAYROLL
DBP ACCOUNT NAME AMOUNT TO BE CREDITED

REQUIRED REQUIRED
GRACE 10,000.00
JOSE 50,000.00
ANDRES 12,000.00
ANTONIO 13,000.00
MARY 14,000.00
CARY JOHN 16,000.00
ADAM 12,123.00
JOEY 21,133.33
PRINCESS 14,785.00
MARIA ANNA 98,569.00