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Republic of the Philippines

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SOCIAL SECURITY SYSTEM

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○ SPECIMEN SIGNATURE CARD

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SSS Form L - 501 (07-94)

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Registered Employer Name (Print in full) I.D. No.

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JADEMICRON PHILIPPINES INC. 04-1031062-3

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Tel. No.
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Address (Print in full)

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BUILDING 8 PANORAMA COMPOUND 5 LAGUNA (049) 530-0467

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TECHNOPARK ANNEX, BINAN, LAGUNA

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Authority to certify or sign documents on all social security matters is hereby delegated to the following officials of the company.
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Printed Name Official Designation Initial Signature

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GLENN T. GOHETIA

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PRESIDENT G.T.G
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CATHERINE T. ANCHORES HR/ADMIN HEAD C.T.A.
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Name and official capacity of person granting authority: Date authority granted:
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(Please sign over printed name.)
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GLENN T. GOHETIA - PRESIDENT

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Internet Edition (7/2000)
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Cut along the dotted line.
Please read reminders on page 2 of this form.
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Republic of the Philippines
○

○
SOCIAL SECURITY SYSTEM
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○
○

○
SPECIMEN SIGNATURE CARD
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○
SSS Form L - 501 (07-94)
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Registered Employer Name (Print in full) I.D. No.
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04-1031062-3
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JADEMICRON PHILIPPINES INC.

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Tel. No.
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Address (Print in full)

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○

BUILDING 8 PANORAMA COMPOUND 5 LAGUNA (049) 530-0467

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TECHNOPARK ANNEX, BINAN, LAGUNA

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Authority to certify or sign documents on all social security matters is hereby delegated to the following officials of the company.
○

Printed Name Official Designation Initial Signature

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○

○
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GLENN T. GOHETIA PRESIDENT G.T.G

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CATHERINE T. ANCHORES HR/ADMIN HEAD C.T.A.

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Name and official capacity of person granting authority: Date authority granted:
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(Please sign over printed name.)

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GLENN T. GOHETIA - PRESIDENT

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Internet Edition (7/2000)

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 IMPORTANT INFORMATION/INSTRUCTIONS
ABOUT YOUR SPECIMEN CARD

1. This form (SSS Form L-501) should be accomplished in two

(2) copies by the responsible officials authorized by the
employer to certify and/or sign documents on the Social
Security System (SSS).

2. Any signature in the space for “Employer’s Representative”

in salary and calamity application forms shall not be honored
unless signatures appear in this form and are filed with the
SSS.

3. The SSS should be notified of any change/revocation or

addition in authorized representative through the submission
of a new specimen signature card to replace or supplement
that on file with the SSS.

4. The registered name, ID number and address of the employer

should be correctly indicated in this form.