HLURB MC No.

Series of 200____
Annex ____

APPLICATION FORM FOR THE AVAILMENT OF CREDITABLE WITHHOLDING TAX

(Pursuant to Sec. 2.57.2(J) of Revenue Regulations No. 2-98
as reiterated by Regional Circular No. 3-2000)

To The Regional Director:

Pursuant to Section 2.57.2(J) of Revenue Regulations No. 2-98, please consider this as an
application for the availment of creditable withholding tax for the following lots:

Registered Lot No./ Name of TCT/ CCT/ Location Certificate of License to

Owner/ Condo. Unit Subd./ Psd No. Registration Sell No.
Developer Condo No.
Project
1.

2.

3.

4.

5.
* Specify the block no./ lot no. or the unit no. and floor level.

Very truly yours,

___________________________
Registered Owner/Developer
Address
Tel. No.

Subscribed and Sworn to before me this _____________ day of 20___, Affiant

exhibiting his/her Residence Certificate No. ________________ issued at
____________________ on ____________________.

Doc. No.
Page No. Notary Public
Book No.
Series of ___________