You are on page 1of 28

Taxpayer's Information

Page 1
Category:
1. For the Year (YYYY):
Month Day Year
2. Taxpayer's Name:
Last Name: First Name: Midde Name:
!. T"N (Taxpayer "denti#i$ation N%m&er):
'. Taxpayer's (egistered )ddress:
No. *dg. +treet and *arangay City, M%ni$ipaity
Month Day Year
-ip Code:
Is spouse claiming additional exemption?
No. o# .%ai#ied Chidren:
/ross Taxa&e Compensation "n$ome
Tax 0ithhed:
(To &e #ied %p &y *"( personne ony)
1ease &e reminded o# the #oo2ing:
1. "np%t on 'gray3#ied' $es ony (other $es $annot &e edited)4
2. Foo2 the instr%$tions gi5en in the inp%t anaysis4
!. 6se a C)1+ i# possi&e4
'. 7nter 8N)9 i# in#ormation is not appi$a&e to $%rrent stat%s.
"np%t
(1ease inp%t on gray $es ony.)
Date o# "T( Fiing (MMM,DD,YYYY): :;7L1<
Date o# *irth (MMM,DD,YYYY): :;7L1<
Teephone,Ce%ar phone N%m&er: :;7L1<
7xemption +tat%s :;7L1<
=ther Taxa&e "n$ome
(Non3&%siness,Non3pro#ession "n$ome
"n$%ding Net "n$ome o# Margina "n$ome 7arners)
Taxpayer's Information
Page 2
Month Day Year
Compromise
Click to view Income Tax Return
Date o# Tax 1ayment
(MMM,DD,YYYY): :;7L1<
+%r$harge Code: :;7L1<
"nterest: :;7L1<
Taxpayer's Information
Page 3
"np%t )naysis
1ease enter a 5aid year.
1ease inp%t $ompete date o# "T( #iing (%se hep in>).
Year
1ease inp%t $ompete name.
Midde Name:
1ease inp%t #irst ? digits o# T"N n%m&er.
1ease inp%t $ompete address.
City, M%ni$ipaity 1ro5in$e
1ease inp%t $ompete date o# &irth (%se hep in>).
Year
1ease inp%t '3digit @ip $ode.
1ease inp%t 5aid $onta$t n%m&er (%se hep in>).
1ease inp%t $orre$t $ode #or exemption stat%s (%se hep in>).
1ease inp%t 'Y' or 'N' ony.
1ease inp%t A3' ony.
1ease inp%t 5aid 'gross taxa&e $ompensation in$ome'.
1ease inp%t 5aid 'other taxa&e in$ome'.
1ease inp%t 5aid tax 2ithhed'.
(To &e #ied %p &y *"( personne ony)
(1ease inp%t on gray $es ony.)
B5ie2 at CAD
@oom #or
$om#orta&e %se
Taxpayer's Information
Page 4
1ease inp%t $ompete date o# &irth (re#er to the in> pro5ided).
Year
1ease inp%t 5aid s%r$harge $ode (%se hep in>).
"s interest appi$a&e :Y,N<E (%se hep in>).
1ease inp%t 5aid $ompromise penaty.
Click to view Income Tax Return here
Taxpayer's Information
Page
+po%se "n#ormation
.%ai#ied Dependents
B5ie2 at CAD
@oom #or
$om#orta&e %se
Taxpayer's Information
Page !
"inal #utput
Page $
%IR "orm &o'
183.1
(Revise) * 2+12,
"or t-e .ear (....,/
PART I Background Information
Taxpaer!"iler #pouse
TI$ TI$
$ame% $ame%
Registered Address% Registered Address%
0ge/ Age%
&ontact $um'er% (ip &ode% &ontact $um'er% (ip &ode%
)xemption #tatus% $um'er of *ualified +ependent &hildren%
Is spouse claiming additional exemption?
PART II &omputation of Tax
Taxpaer% #pouse%
1ross Taxa2le Compensation Income/
#t-er Taxa2le Income/
,ross Taxa'le Income%
Personal 3xemption/
0))itional 3xemption/
Total )xemption%
Taxa'le Income%
Tax +ue%
Tax -ithheld%
Tax Paa'le!./erpament
4urc-arge
Interest
Compromise
Total Penalties%
Total Amount Paa'le! ./erpament%
PART III Additional Information
Taxpaer!"iler% #pouse%
*ualified +ependents0 Information
$ame% +ate of Birth 1222!++!33334%
5ast $ame% "irst $ame% 2iddle $ame% 2onth +a 3ear
Repu2lika ng Pilipinas
5agawaran ng Pananalapi
5awani-an ng Rentas Internas
Annual Income
Tax Return
"or In)ivi)uals 3arning Compensation Income
(Inclu)ing &on*%usiness 6 &on*Profession Relate) Income,
+ate of Birth 122!++!33334% +ate of Birth 122!++!33334%
I )eclare7 un)er t-e penalties of per8ury7 t-at t-is return -as 2een ma)e in goo) fait-7 verifie) 2y me7 an) to t-e 2est of my knowle)ge an) 2elief7
Is true an) correct7 pursuant to t-e provisions of t-e &ational Internal Revenue Co)e7 as amen)e)7 an) regulations issue) un)er aut-ority t-ereof'
999999999999999999999999999999999999999999999999999999
Taxpayer60ut-ori:e) 0gent (4ignature over Printe) &ame,
Tax Pament 122!++!33334
"inal #utput
Page ;
%ack to <Taxpayer's Information=
"inal #utput
Page >

"inal #utput
Page 1+
1' ?ate "ormat
Page 11
Please refer to the follo6ing examples for the dates%
MMM DD YYYY
Fan%ary 1 1??A
Fe&r%ary 2 1??G
Mar$h ! 1??C
)pri ' 1???
May H 2AAA
F%ne I 2AA1
F%y G 2AA2
)%g%st C 2AA!
+eptem&er ? 2AA'
=$to&er 1A 2AAH
No5em&er 11 2AAI
De$em&er !1 2A12
%ack to <Taxpayer's Information=
1o to <4pouse Information=
1o to <@ualifie) ?epen)ents' Info=
2' Contact &um2er
Page 12
1ease re#er to the #oo2ing exampes #or teephone, $e%ar phone n%m&er:
HHH1122
AH!A?A?
!2H12!'
H22?CGI
H22C1C1
A?A?1122!!!
A?12!'HIGC?
A?'H1A1A1A1
A?22A?CGIH'
A?1?1?1?CCC
%ack to <Taxpayer's Information=
3' 3xemption 4tatus
Page 13
Please use the following codes for exemption status:
Code:
+
;
M
%ack to <Taxpayer's Information=
3' 3xemption 4tatus
Page 14
Please use the following codes for exemption status:
7xemption +tat%s: )mo%nt:
+inge 1hp'AJAAA.AA
;ead o# Famiy 1hpIAJAAA.AA
Married 1hpHAJAAA.AA
%ack to <Taxpayer's Information=
4' Tax Ta2le
Page 1
Tax Ta&e
"# Taxa&e "n$ome is:
Not o5er 1 1AJAAA
=5er 1 1AJAAA &%t not o5er 1 !AJAAA
=5er 1 !AJAAA &%t not o5er 1 GAJAAA
=5er 1 GAJAAA &%t not o5er 1 1'AJAAA
=5er 1 1'AJAAA &%t not o5er 1 2HAJAAA
=5er 1 2HAJAAA &%t not o5er 1 HAAJAAA
=5er 1 HAAJAAA
%ack to <Taxpayer's Information=
4' Tax Ta2le
Page 1!
Tax Ta&e
Tax D%e is:
HD
1 HAA K 1A D o# the ex$ess o5er 1 1AJAAA
1 2JHAA K 1H D o# the ex$ess o5er 1 !AJAAA
1 CJHAA K 2A D o# the ex$ess o5er 1 GAJAAA
1 22JHAA K 2H D o# the ex$ess o5er 1 1'AJAAA
1 HAJAAA K !A D o# the ex$ess o5er 1 2HAJAAA
1 12HJAAA K !' D o# the ex$ess o5er 1 HAAJAAA
%ack to <Taxpayer's Information=
' 4pouse Info
Page 1$
Category
2. +po%se's Name:
Last Name: First Name:
!. +po%se's T"N:
'. +po%se's (egistered )ddress:
No. *dg. +treet and *arangay City, M%ni$ipaity
Month Day
-ip Code:
Teephone,Ce%ar phone N%m&er:
/ross Taxa&e Compensation "n$ome
Tax 0ithhed:
Month Day
Compromise
"np%t
(1ease inp%t on 'gray3#ied' $es ony)
Date o# *irth (MMM,DD,YYYY): :;7L1<
=ther Taxa&e "n$ome
(Non3&%siness,Non3pro#ession "n$ome
"n$%ding Net "n$ome o# Margina "n$ome 7arners)
Date o# Tax 1ayment
(MMM,DD,YYYY): :;7L1<
+%r$harge Code: :;7L1<
"nterest: :;7L1<
' 4pouse Info
Page 1;
%ack to <Taxpayer's Information=
' 4pouse Info
Page 1>
First Name: Midde Name:
City, M%ni$ipaity 1ro5in$e
Day Year
Day Year
(1ease inp%t on 'gray3#ied' $es ony)
' 4pouse Info
Page 2+
%ack to <Taxpayer's Information=
' 4pouse Info
Page 21
"np%t )naysis
1ease inp%t $ompete name.
1ease inp%t #irst ? digits o# T"N n%m&er.
1ease inp%t $ompete address.
1ease inp%t $ompete date o# &irth (%se hep in>).
1ease inp%t '3digit @ip $ode.
1ease inp%t 5aid $onta$t n%m&er.
1ease inp%t 5aid 'gross taxa&e $ompensation in$ome'.
1ease inp%t 5aid 'other taxa&e in$ome'.
1ease inp%t 5aid tax 2ithhed'.
1ease inp%t $ompete date o# &irth (%se hep in>).
1ease inp%t 5aid s%r$harge $ode (%se hep in>).
"s interest appi$a&e :Y,N<E (%se hep in>).
1ease inp%t 5aid $ompromise penaty.
' 4pouse Info
Page 22
!' @ualifie) ?epen)ents' Info
Page 23
Name:
Last Name: First Name: Midde Name: Month
.%ai#ied Dependents' "n#ormation
(1ease inp%t on 'gray3#ied' $es ony.)
Date o# *irth (MMM,DD,YYYY): :;7L1<
)n additiona exemption o# 1hp2HJAAA.AA sha &e ao2ed #or ea$h L%ai#ied dependent $hidJ not ex$eeding #o%r ('). The additiona exemption #or dependents
+ha &e $aimed &y the h%s&andJ 2ho is deemed the head o# the #amiy %ness he expi$ity 2ai5es his right in #a5or o# his 2i#e.
%ack to <Taxpayer's Information=
!' @ualifie) ?epen)ents' Info
Page 24
"np%t )naysis
Month Day Year
1ease inp%t 5aid name and date o# &irth.
1ease inp%t 5aid name and date o# &irth.
1ease inp%t 5aid name and date o# &irth.
1ease inp%t 5aid name and date o# &irth.
.%ai#ied Dependents' "n#ormation
(1ease inp%t on 'gray3#ied' $es ony.)
Date o# *irth (MMM,DD,YYYY): :;7L1<
)n additiona exemption o# 1hp2HJAAA.AA sha &e ao2ed #or ea$h L%ai#ied dependent $hidJ not ex$eeding #o%r ('). The additiona exemption #or dependents
+ha &e $aimed &y the h%s&andJ 2ho is deemed the head o# the #amiy %ness he expi$ity 2ai5es his right in #a5or o# his 2i#e.
%ack to <Taxpayer's Information=
$' 4urc-arge
Page 2
1ease %se the #oo2ing $odes #or s%r$harge:
Code:
)
*
C
D
7
F
N
$' 4urc-arge
Page 2!
1ease %se the #oo2ing $odes #or s%r$harge:
Nat%re,Des$ription:
Fai%re to #ie any ret%rn and pay the amo%nt o# tax or instament d%e on or &e#ore the d%e date4
Fai%re to pay the de#i$ien$y tax 2ithin the time pres$ri&ed #or its payment in the noti$e o# assessment4
0i#% nege$t to #ie the ret%rn 2ithin the period pres$ri&ed &y the Code or &y r%es and reg%ations4
"n $ase a #ase or #ra%d%ent ret%rn is 2i#%y made4
No 5ioations $ommitted.
6ness other2ise a%thori@ed &y the CommissionerJ #iing a ret%rn 2ith a person or o##i$e other than
Those 2ith 2hom it is reL%ired to &e #ied4
Fai%re to pay the #% or part o# the amo%nt o# tax sho2n on the ret%rnJ or the #% amo%nt o# tax d%e
For 2hi$h no ret%rn is reL%ired to &e #ied on or &e#ore the d%e date4
%ack to <Taxpayer's Information=
1o to <4pouse Information=
$' 4urc-arge
Page 2$
1ease %se the #oo2ing $odes #or s%r$harge:
2HD
2HD
2HD
2HD
HAD
HAD
AD
+%r$harge
(D o# Tax 1aya&e)
;' Interest
Page 2;
"nterest at the rate o# t2enty per$ent (2AD) per ann%m on any
6N1)"D amo%nt o# tax #rom the the 1st o# May %nti it is #%y paid.
%ack to <Taxpayer's Information=
/o to 8+po%se "n#ormation9