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(To be filled up by the BIR)

DLN:

Taxpayer PSOC:

PSIC:

Spouse PSOC:

PSIC:
BIR Form No.

Quarterly Income
Tax Return

Republika ng Pilipinas
Kagawaran ng Pananalapi

Kawanihan ng Rentas Internas


For Self-Employed Individuals, Estates, and Trusts
(Including those w/ both Business & Compensation Income)

1701Q
July 2008 (ENCS)

Fill in all applicable spaces. Mark all appropriate boxes with an X.

For the Year


(YYYY)
Part I
TIN

5
9

2 Quarter

2 0 1
6

1st

3 Amended
2nd
3rd
Return
Background Information

Yes

Taxpayer/Filer

2 23

331

No

4 No. of sheet/s
attached

Spouse
6 RDO
Code

960

25B

Taxpayer's Name(Last Name, First Name, Middle Name)(Estates & Trusts)

TIN

8 RDO
Code

10

Spouse's Name (Last Name, First Name, Middle Name)(If applicable)

12

Registered Address

DEPLA, FLORDELIZA PELOBELLO


11

Registered Address

901 PARADA STA MARIA BULACAN


13 Date of Birth (MM/DD/YYYY)

08

02

14 Zip Code 15 Telephone Number 16 Date of Birth (MM/DD/YYYY)

1970

19 Line of Business/Occupation

3022
20

II 011

ATC I I 0 1 2

SERVICE

II 013

23 Method of Deduction
Itemized Deduction

Compensation
Business
Mixed Income

40% Optional Standard Deduction

21 Line of Business/Occupation

Professional Partnership (except loans)

Total
Less: Cost of Sales/Services
Gross Income from Operation
Add: Other Income
Total Gross Income
Less: Deductions
Taxable Income This Quarter
Add: Taxable Income Previous Quarter/s
Taxable Income to Date
Tax Due
Less: Tax Credits/Payments
38A/B Prior Years' Excess Credits
38C/D Tax Payment/s for the Previous Quarter/s
38E/F Creditable Tax Withheld for the Previous Quarter/s
38G/H Creditable Tax Withheld Per BIR Form No. 2307

for this Quarter

38I/J Tax Paid in Return Previously Filed,

II 011
II 013

24 Method of Deduction
Itemized Deduction
No

18 Telephone Number

40% Optional Standard Deduction

Spouse
26B 0.00
27B 0.00

30,000.00
15,000.00
15,000.00
0.00
15,000.00
9,800.00
5,200.00
900.00
6,100.00
305.00

28B 0.00
29B 0.00
30B 0.00
31B 0.00
32B 0.00
33B 0.00
34B 0.00
35B 0.00
36B 0.00
37B 0.00

38A

0.00
0.00
0.00
0.00
0.00
0.00
0.00

38B 0.00

305.00
0.00
0.00
0.00
0.00
305.00

39B 0.00
40B 0.00
40D 0.00
40F 0.00
40H 0.00

38C
38E
38G
38I
38K

38M/N Total Tax Credits/Payments (Sum of 38A,C,E,

38M

39 Tax Payable/(Overpayment) (37A less 38M & 37B less 38N)


40
Add: Penalties
Surcharge
Interest
Compromise
Total Penalties (Sum of Items 40A,C,E/40B,D,F)

39A
40A
40C
40E
40G

41 Total Amount Payable/ (Overpayment)(39A+40G/39B+40H)

41A

Aggregate Amount Payable/(Overpayment) ( Sum of Items 41A & 41B)

Compensation
Business
Mixed Income

If yes, specify

28A
29A
30A
31A
32A
33A
34A
35A
36A
37A

if this is an Amended Return


38K/L Other Payment/s Made (please attach proof of
payment-BIR Form No. 0605)
G,I & K/ 38B,D,F,H,J,& L)

22

ATC I I 0 1 2

25 Are you availing of tax relief under Special Law or International Tax Treaty?
Yes
Part II
Computation of Tax
Declaration This Quarter
Taxpayer/Filer
26 Sales/Revenues/Receipts/Fees
26A 30,000.00
27
Add: Amount Received by a Partner from General
27A
0.00
28
29
30
31
32
33
34
35
36
37
38

17 Zip Code

09432251898

38D 0.00
38F

0.00
0.00
38J
0.00
38L
0.00
38N 0.00
38H

41C

41B 0.00

305.00

I declare under penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my 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.
42
Taxpayer/Authorized Representative/Accredited Tax Agent
Signature Over Printed Name

Title/Position of Signatory

TIN of Signatory

Tax Agent Acc. No./Atty's Roll No. (if applicable)

Date of Issuance

Date of Expiry

Part III
Particulars
43 Cash/Bank
Debit Memo
44 Check
45 Tax Debit
Memo
46 Others

D e t a i l s of P a y m e n t
Date
Number
MM DD

Drawee Bank/
Agency

YYYY

Amount

43A

43B

43C

43D

44A

44B

44C

44D

45A

45B

45C

46B

46C

46D

46A

Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

\mariam

Stamp of Receiving Office/


AAB and Date of Receipt
(RO's Signature/
Bank Teller's Initial

BIR FORM 1701Q (ENCS)-PAGE 2


TAX TABLE
If TAXABLE INCOME is:
Not over P 10,000
Over
P 10,000 but not over
Over
P 30,000 but not over
Over
P 70,000 but not over
Over
P 140,000 but not over
Over
P 250,000 but not over
Over
P 500,000

TAX DUE is:


5%
P
500 + 10%
P 2,500 + 15%
P 8,500 + 20%
P 22,500 + 25%
P 50,000 + 30%
P 125,000 + 32%

P 30,000
P 70,000
P 140,000
P 250,000
P 500,000

BIR Form 1701Q - Quarterly Income Tax Return


GUIDELINES AND INSTRUCTIONS

of the excess over


of the excess over
of the excess over
of the excess over
of the excess over
of the excess over

P 10,000
P 30,000
P 70,000
P 140,000
P 250,000
P 500,000