Republic of the Philippines

SOCIAL SECURITY SYSTEM

Legazpi Branch
Imperial Court Subd., Legazpi City
(052) 480-7076 Fax No. 480-7074

AUTHORITY TO DEDUCT

The following employees with their SS number and whose signature appears beside of
their SS number, here by authorize their employer Department of Labor and Employment Region
5, to deduct from their monthly salary the amount of Four Hundred Ninety-Eight and 75/100
Pesos only (Php 498.75) starting February 2024 representing my premium contribution for
Social Security System under their Expanded Self-Employed Program, and to remit the same to
SSS.

No. Name SS Number ID Presented Signature

1 Barias, Dixter B. 05-1123727-8 Driver’s License
No.: EO2-21-200504
2. Torreda, Janette L. 35-0009571-6 TIN ID NO.:
512-442-897-000

It is understood that this authority to deduct shall continue to be effective during my

employment with above employer or until revoked by writing by the undersigned.

Signature over Printed Name of

Authorized Representative & Designation