Professional Documents
Culture Documents
01
1 For the Period
02/01/18 02/21/18
From (MM/DD/YY) To (MM/DD/YY)
Part I Income Recipient/Payee Information Withholding Agent/Payor Information
2 TIN 3 TIN 000989 162 000
900 108 706 000
4 Payee's Name (For Non-Individuals ) 5 Payor's Name (For Non- Individuals)
A.C. Atencio Aluminum Supply MUNICIPALITY OF CAPAS
6 Payee's Name (Last Name, First Name, Middle Name) For Individua7 Payor's Name (Last Name, First Name, Middle Name) For Individuals
Part II Details of Income Payment and Tax Withheld (Attach additional sheet if necessary)
Nature of Income Payment ATC Amount of Payment Tax Withheld
Various Materials 54,910.71 2% 1,098.21
Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
CONFORME:
Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)
I declare, under the penalties of perjury, that the information I declare under the penalties of perjury that I am qualified under substituted filing of Percentage
herein stated are reported under BIR Form No. 1600 which Tax/Value Added Tax Returns (BIR Form 2551M/2550M/Q), since I have only one payor from
have been filed with the Bureau of Internal Revenue. whom I earn my income; that, in accordance with RR 14-2003, I have availed of the Optional
Registration under the 3% Final Percentage Tax Wthholding/10% Final VAT Withholding in lieu
of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges accorded by the
Substituted Percentage Tax Return/Substituted VAT Return System prescribed in the aforesaid
Payor/Payor's Authorized Representative/Accredited Tax Agent Regulations; that, this Declaration is sufficient authority of the withholding agent to withhold 3%
Signature Over Printed Name Final Percentage Tax/10% Final VAT from my sale of goods and/or services.
TIN of Signatory Title/Position of Signatory Payee/Payee's Authorized Representative/Accredited Tax Agent Title/Position of Signatory
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Tax Agent Accreditation No./Attorney's Roll No. (if applicable) TIN of Signatory
Payor Information
6 Taxpayer
Identification Number 000 989 162 000
7 Payor's Name MUNICIPALITY OF CAPAS
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
8 Registered Address 8A Zip Code
Sto. Domingo II, Capas, Tarlac 2315
PART II Details of Monthly Income Payments and Tax Withheld for the Quarter
Income Payments Subject to AMOUNT OF INCOME PAYMENTS
ATC
Expanded Withholding Tax 1st Month of 2nd Month of 3rd Month of Total Tax Withheld
the Quarter the Quarter the Quarter For the Quarter
Total - -
Money Payments Subject to Withholding
of Business Tax (Government & Private)
Various Materials 1% 54,910.71 549.11
Total 54,910.71 549.11
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by me, and to the best of my knowledge and belief, is true and co
pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
Conforme:
Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
(Signature Over Printed Name)
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
02/01/18 02/21/18
Company Name A.C. Atencio Aluminum Supply
Address Capas, Tarlac
Tin 900 108 706 000
Purpose Various Materials
Gross 54,910.71
2% 1%
1,098.21 549.11