Professional Documents
Culture Documents
IAET
IAET
DLN:
BCS No.
Republika ng Pilipinas
Kagawaran ng Pananalapi
Part I
Background
TIN
Taxpayer's Name
1704
May 2001
ATC
No
7 0
Information
8 Line of Business/
Occupation
RDO Code
10 Registered Address
12 Date of Incorporation
(MM/DD/YYYY)
Part II
PSIC:
11 Zip Code
12A
12B
13 Taxable Income
13
14B
14C
14D
15
15A
15B
15C
15D
16
16A
16B
16C
16D
17
17A
17B
18
19
20
20
21
Less:
(See Schedule I)
22 Improperly Accumulated Taxable Income (Item 18 less Item 21B)
21A
21B
22
23 Tax Rate
23
Add:
10%
24
Penalties
Surcharge
Interest
25A
Compromise
25B
25C
25D
26
We declare, under the penalties of perjury, that this return has been made in good faith, verified by us, and to the best of our 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.
27
28
Treasurer/Asst. Treasurer/Authorized Representative
(Signature over printed Name)
President/Vice-President/Authorized Representative
(Signature over printed Name)
Tax Agent
Date Issued
MM
DD
YYYY
Place of Issue
30
31
35 Tax Debit
35A
Memo
36A
36B
36 Others
32
D e t a i l s of P a y m e n t
Date
Number
MM DD
YYYY
Drawee Bank/
Particulars
Agency
33 Cash/Bank
Debit Memo.
34A
34B
34C
34 Check
Amount
33
34D
35B
35C
36C
36D
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
Amount
Stamp of Receiving
Office and
Date of Receipt
Schedule I
(2)
(3)
(4)
Penalties
There shall be imposed and collected as part of the tax:
A surcharge of twenty five percent (25%) for each of the
following violations:
a) Failure to file any return and pay the amount of
tax or installment due on or before the due date;
or
b) Unless
otherwise
authorized
by
the
Commissioner, filing a return with a person or
office other than those with whom it is required
to be filed; or
c) Failure to pay the full or part of the amount of tax
shown on the return on or before the due date; or
d) Failure to pay the deficiency tax within the time
prescribed for its payment in the notice of
assessment.
2. A surcharge of fifty percent (50%) of the tax or of the
deficiency tax, in case any payment has been made on the
basis of such return before the discovery of the falsity or
fraud, for each of the following violations:
a) Willful neglect to file the return within the period
prescribed by the code or by rules and
regulations; or
b) In case a false or fraudulent return is willfully
made.
3. Interest at the rate of twenty percent (20%) per annum or
such higher rates as may be prescribed by rules and
regulations, on any unpaid amount of tax, from the date
prescribed for the payment until it is fully paid.
4. Compromise penalty.
1.
Attachments:
1.
2.