NOTICE OF AVAILMENT OF TAX AMNESTY

Under Republic Act No. 9480

___________________________ (Date) The Commissioner of Internal Revenue BIR National Office Building Diliman, Quezon City Attention: Revenue District Officer ______________________ Revenue District Office No. ___________________ Revenue Region No. _________________________ Sir/Madam: I/We hereby notify your Office that _______________________________________________________ __________,
(Name of Taxpayer)

with TIN __________________ and registered address at _______________________________________________________ ______________________________ would like to avail of the tax amnesty under R.A. No. 9480, as implemented by Department Order No. 29-07. Attached are the required documents: 1. Statement of Assets, Liabilities and Networth (SALN) as of December 31, 2005 Without previous SALN /Balance Sheet - SALN as of December 31, 2005 With previous SALN /Balance Sheet - Original declaration - Amended declaration 2. 3. Tax Amnesty Return (BIR Form No. 2116) Tax Amnesty Payment Form/Acceptance of Payment Form (BIR Form No. 0617)

I declare under the penalties of perjury, that this statement and the attached documents mentioned above have been made in good faith, verified by me and I attest to the correctness and completeness of the declaration therein.

_____________________________
President/Vice President/Principal Officer/ Authorized Representative/Taxpayer (Signature Over Printed Name)

Stamp of Receiving Office and Date of Receipt (ROs Signature Over Printed Name)

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