Professional Documents
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DLN:
PSIC:
Quarterly Value-Added
Republika ng Pilipinas
Kagawaran ng Pananalapi
2550Q
Tax Return
Calendar
Year Ended
( MM / YYYY )
6 TIN
Fiscal
2 Quarter
1st
From
3 Return
3rd
7 1 2015
9 30 2015
Period
2nd
4th
(mm/dd/yy) To
8 No. of sheets
Code
attached
10 Taxpayer's Name (For Individual)Last Name, First Name, Middle Name/(For Non-individual) Registered Name
1 2
2015
0 3 7 7 7 0 2 0 0 0
0 0
4 Amended
9 Line of
Business
0
1
Yes
5 Short
Return?
11
x No
Manufacturing/whole sale
13
Yes
3 8 1 9
1 1 4 0
If yes, specify
No
Part II
15A
16 Sale to Government
16A
150,486.43
15B
18,058.37
16B
17
18
18 Exempt Sales/Receipts
150,486.43
19B
18,058.37
20A
0.00
20B Input Tax Deferred on Capital Goods Exceeding P1Million from Previous Quarter
20B
20C
20D
20E
20F
21A
21C
21E
21G
21I
21K
21M
21N
21P
19A
No
Zip Code
Yes
Telephone Number
7 4 1
12 Registered Address
Period
Return?
21
21B
21D
21F
21H
21J
21L
102,300.70
0.00
102,300.70
22
12,276.08
23A
23B
23C
23D
23E
23F
24
25
0.00
0.00
0.00
12,276.08
5,782.29
26A
26B
26C
26D
26E
26F
26G
1,737.65
0.00
26H
1,737.65
4,044.64
27
Surcharge
Interest
28A
0.00
0.00
12,276.08
0.00
21O
28 Add: Penalties
0.00
Purchases
0.00
Compromise
28B
28C
28D
29
0
4,044.64
I declare, under the penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my knowledge, and belief,
is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
JACINTO TAN
30
31
Treasurer/Assistant Treasurer
(Signature Over Printed Name)
General Manager
Title/Position of Signatory
TIN of Signatory
Date of Issuance
Part III
Title/Position of Signatory
Date of Expiry
TIN of Signatory
Details of Payment
Drawee Bank/
Particulars
32 Cash/Bank 32A
Date
Agency
Number
MM DD
YYYY
Amount
32B
32C
32D
33B
33C
33D
34A
34B
34C
35B
35C
35D
Debit Memo
33 Check
33A
34 Tax Debit
Memo
35 Others
35A
Stamp of
Receiving Office/AAB
Machine Validation (if filed with an accredited agent bank)/Revenue Official Receipt Details (If not filed with an Authorized Agent Bank)
(RO's Signature/
Bank Teller's Initial)
AT
Previous 2 Mos.
Current Mo.
Instruction:This workbook is link to ITR of FMC 1702q. Open it at the same time