Annex “C”

Revenue District Office No. ___, _________________

Large Taxpayers Division/Large Taxpayers Collection Enforcement Division

NOTICE OF ISSUANCE OF AUTHORITY TO CANCEL ASSESSMENT

Control No. RR-RDO/Office Code-Serial Number

Date of Issue:____________________________

NAME OF TAXPAYER
TAXPAYER IDENTIFICATION NUMBER
REGISTERED ADDRESS

Dear __________:

This is to inform you that the tax liabilities covered by the Tax Amnesty Return filed on
____________, for which a total of P__________ tax amnesty payment have been made, have already
been cancelled through the approved Authority to Cancel Assessment (ATCA), as follows:

Tax Liabilities Covered by Tax Amnesty ATCA

Taxable Year Tax Types Amount per Amount Amount Date Number
FAN/FLD/FDDA Paid Cancelled

However, it is further informed that tax liabilities which are not covered by FAN/FLD/FDDA
were not issued ATCA. For your information.

Very truly yours,

(Signature over Printed Name)

Printed Name of Chief, RCD/LTD/LTCED