ANNEX B-1:

GUIDE ON
FILLING UP THE
DOCUMENT
 ANNEX “B-1”

INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES

(For Self-Employed and/or Engaged in the Practice of Profession with Several Income Payors)

I, (1) Tutor’s Full Name , (2) Tutor’s Citizenship , of legal age, (3) single/ married to
(Name) (Citizenship)
(4) Tutor’s Spouse (Full Name) permanently residing at _________________________________
(Name of Spouse)
(5) Tutor’s Address with
(Address)
Taxpayer Identification Number (TIN) (6) Tutor’s TIN , after having been duly sworn in accordance with law

hereby depose and state:

1. That I derived my (7) Professional income from various income payors, and my registered business address is at
(business/professional)
(8) Tutor’s Business Address ;
(Business Address)

2. That for the current year (9) Year , my gross receipts will not exceed Three Million Pesos (₱3,000,000) and that I am a non-
VAT registered taxpayer. For this purpose, I opt to avail of either one of the income tax regime as follows:
(10) Graduated Income tax rate
 Graduated Income Tax Rates under Section 24(A)(2)(a) of the Tax Code, as amended, based on the taxable
income. With this selection, I acknowledge that I am subject to creditable withholding tax at the prescribed
rate; subject to percentage tax and will file the required percentage tax returns or subject to withholding
percentage tax, in case of government money payments.
(11) Eight Percent (8%) Income tax rate
 Eight Percent (8%) income tax rate under Section 24(A)(2)(b) of the Tax Code, as amended, based on gross
receipts/sales and other non-operating income - with this selection, I understand that this is in lieu of the
graduated income tax rates and the Percentage Tax under Section 116 of the Tax Code, as amended; thus,
only the creditable income withholding tax based on the prescribed rate shall be made;

3. That based on my selection above, if my gross sales/receipts and other non-operating income exceeds ₱3,000,000, my income
payor /withholding agents shall automatically withhold the higher rate of withholding of ten percent (10%) in the case of
income items with two (2) prescribed creditable withholding tax rate depending on the total amount of income payment
received:

a. In case of Graduated Income Tax Rates, I acknowledge that aside from income tax, I am subject to business
tax (VAT) unless expressly exempted; and consequently subject to withholding of income. Moreover, if the
payor is a government entity, business tax withholding applies; OR

b. In case of Eight Percent (8%) income tax rate, I acknowledge that I am no longer qualified to avail of this
option since my income exceeds ₱3,000,000 and thus, the graduated income tax rates above shall
automatically apply together with the consequent liability for business tax/es;

(12)
4. That I duly execute this SWORN DECLARATION in compliance with the requirement prescribed under Section 2 of
Revenue Regulations No. 11-2018 ;

5. That I declare, under the penalties of perjury, that this declaration has been made in good faith, and to the best of my knowledge
and belief to be true and correct.
(13)
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at ___________, Philippines

(14) .
Signature over Printed Name of Individual Taxpayer

(15)
SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in _______________________________.
Applicant exhibited to me his/her ___________________________issued at _______________________ on _________________________.
(Government Issued ID and No.)

NOTARY PUBLIC
Doc. No.: __________
Page No.: __________
Book No.: __________
Series of ___________

Affix ₱15.00 Affix ₱15.00

Documentary Documentary
Stamp Tax Stamp Tax (16)

(To be filled-out by the withholding agent/lone payor)

Date Received: __________________ Received by:

(MM-DD-YYYY-00001)
_____________________________________________________________
Signature over Printed Name of the Withholding Agent/Payor or Authorized Officer

_____________________________________________________________
Designation/Position of Authorized Officer

_____________________________________________________________
Name of Withholding Agent/Lone Payor
Guide:

1. Tutor’s Full Name: This should match Name indicated in Certificate of Registration.

2. Tutor’s Citizenship

3. Single/Married: Tutor must underline whichever is applicable.

4. Tutor’s Spouse Full Name: If tutor selected Married in #3, this must be filled up with the full name
of Tutor’s Spouse.

5. Tutor’s Permanent Address: This should match Registered Address indicated in Certificate of
Registration if Tutor’s Permanent Address is the same with Tutor’s Business Address.

6. Tutor’s TIN: This should match TIN indicated in Certificate of Registration.

7. Professional: Tutor must input Professional in the space provided.

8. Tutor’s Business Address: This should match Registered Address indicated in Certificate of
Registration and Tutor’s Permanent Address indicated in #5 if the same address only.

9. Year: Tutor must input Year he or she wants to avail the lower withholding tax rate in the space
provided.

10. Graduated Income tax rate: If Tutor chooses this box, #11 must not be selected. Tutor must select
one box only between #10 and #11.

11. Eight Percent (8%) Income tax rate: If Tutor chooses this box, #10 must not be selected. Tutor must
select one box only between #10 and #11.

12. That I duly execute this SWORN DECLARATION in compliance with the requirement prescribed
under Section 2 of Revenue Regulations No. 11-2018;

13. Tutor must input the date and place of signing the document.

14. Tutor must input signature over printed name.

15. This part must be filled up by the notary public.

16. Tutor must attach 2 pieces of P15 Documentary Stamp.

 ANNEX B-2:
GUIDE ON
FILLING UP THE
DOCUMENT
 ANNEX “B-2”

INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES

(For Self-Employed and/or Engaged in the Practice of Profession with Lone Income Payor)

I, (1) Tutor’s Full Name , (2) Tutor’s Citizenship , of legal age, (3) single/ married to
(Name) (Citizenship)
(4) Tutor’s Spouse (Full Name) permanently residing at _________________________________
(Name of Spouse)
(5) Tutor’s Address with
(Address)
Taxpayer Identification Number (TIN) (6) Tutor’s TIN , after having been duly sworn in accordance with law

hereby depose and state:

6. That I derived my (7) Professional income only from (8) RareJob Inc. ,
(business/professional) (Name of Lone Payor)
with Taxpayer Identification Number (9) 436-913-185 and business address at
(10) Kyocera Harajuku Building 2F Jingumae 6-27-8, Shibuya-ku, Tokyo ;

7. That for the current year (11) Year , my gross receipts will not exceed Two Hundred Fifty Thousand Pesos (₱250,000.00)
and that I am registered as a non-VAT taxpayer; that whatever is the amount of income received, I will comply with the
requirement to file my Income Tax Return on the prescribed due date. For this purpose, I opt to avail of either one of the
following:
(12) Graduated Income tax rate
 Graduated Income Tax Rates under Section 24(A)(2)(a) of the Tax Code, as amended, based on the taxable
income. With this selection, I acknowledge that I am subject to 0% income tax, thus, not subject to creditable
withholding tax; subject to percentage tax, if applicable, and will file the required percentage tax returns or
subject to withholding percentage tax, in case of government money payments.
(13) Eight Percent (8%) Income tax rate
 Eight Percent (8%) income tax rate under Section 24(A)(2)(b) of the Tax Code, as amended, based on gross
receipts/sales and other non-operating income - with this selection, I understand that this is in lieu of the
graduated income tax rates and the Percentage Tax under Section 116 of the Tax Code, as amended; thus,
no withholding tax shall be made;

8. That based on my selection above, if my gross sales/receipts and other non-operating income exceeds ₱250,000.00 but not over
₱3,000,000.00, my afore-stated lone income payor shall automatically withhold the prescribed rate of withholding tax:

c. In case of Graduated Income Tax Rates, I acknowledge that aside from income tax, I am subject to business
tax (Percentage Tax, if applicable) and creditable withholding of income in excess of P250,000.00, and
business tax withholding, if any, are applicable on the entire income payment; OR

d. In case of Eight Percent (8%) income tax rate, I acknowledge that I am only subject to income tax and thus,
to the creditable withholding income tax in excess of P250,000.00;

(14)
9. That I duly execute this SWORN DECLARATION in compliance with the requirement prescribed under Section 3 of
Revenue Regulations No. 11-2018 ;

10. That I declare, under the penalties of perjury, that this declaration has been made in good faith, and to the best of my knowledge
and belief to be true and correct.
(15)
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at ___________, Philippines

(16) .
Signature over Printed Name of Individual Taxpayer

(17)
SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in _______________________________.
Applicant exhibited to me his/her ___________________________issued at _______________________ on _________________________.
(Government Issued ID and No.)

NOTARY PUBLIC
Doc. No.: __________
Page No.: __________
Book No.: __________
Series of ___________

Affix ₱15.00 Affix ₱15.00

Documentary Documentary
Stamp Tax Stamp Tax (18)

(To be filled-out by the withholding agent/lone payor)

Date Received: __________________ Received by:

(MM-DD-YYYY-00001)
_____________________________________________________________
Signature over Printed Name of the Withholding Agent/Payor or Authorized Officer

_____________________________________________________________
Designation/Position of Authorized Officer

_____________________________________________________________
Name of Withholding Agent/Lone Payor
Guide:

1. Tutor’s Full Name: This should match Name indicated in Certificate of Registration.

2. Tutor’s Citizenship

3. Single/Married: Tutor must underline whichever is applicable.

4. Tutor’s Spouse Full Name: If tutor selected Married in #3, this must be filled up with the full name
of Tutor’s Spouse.

5. Tutor’s Permanent Address: This should match Registered Address indicated in Certificate of
Registration if Tutor’s Permanent Address is the same with Tutor’s Business Address.

6. Tutor’s TIN: This should match TIN indicated in Certificate of Registration.

7. Professional: Tutor must input Professional in the space provided.

8. Lone Payor: Tutor must input RareJob Inc. in the space provided.

9. Lone Payor’s TIN: Tutor must input 436-913-185 in the space provided.

10. Lone Payor’s Address: Tutor must input Kyocera Harajuku Building 2F Jingumae 6-27-8, Shibuya-
ku, Tokyo in the space provided.

11. Year: Tutor must input Year he or she wants to avail the lower withholding tax rate in the space
provided.

12. Graduated Income tax rate: If Tutor chooses this box, #11 must not be selected. Tutor must select
one box only between #11 and #12.

13. Eight Percent (8%) Income tax rate: If Tutor chooses this box, #10 must not be selected. Tutor must
select one box only between #11 and #12.

14. That I duly execute this SWORN DECLARATION in compliance with the requirement prescribed
under Section 3 of Revenue Regulations No. 11-2018;

15. Tutor must input the date and place of signing the document.

16. Tutor must input signature over printed name.

17. This part must be filled up by the notary public.

18. Tutor must attach 2 pieces of P15 Documentary Stamp.

BLANK COPY OF
ANNEX B-1 & B-2
Use the copies for submission
 ANNEX “B-1”

INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES

(For Self-Employed and/or Engaged in the Practice of Profession with Several Income Payors)

I, _________________________________________________, ___________________________, of legal age, single/ married to

(Name) (Citizenship)
_____________________________________________________ permanently residing at _________________________________
(Name of Spouse)
____________________________________________________________________________________________________________ with
(Address)
Taxpayer Identification Number (TIN) __________________________________, after having been duly sworn in accordance with law

hereby depose and state:

11. That I derived my _______________________ income from various income payors, and my registered business address is at
(business/professional)
________________________________________________________________________________________;
(Business Address)

12. That for the current year ________, my gross receipts will not exceed Three Million Pesos (₱3,000,000) and that I am a non-
VAT registered taxpayer. For this purpose, I opt to avail of either one of the income tax regime as follows:

 Graduated Income Tax Rates under Section 24(A)(2)(a) of the Tax Code, as amended, based on the taxable
income. With this selection, I acknowledge that I am subject to creditable withholding tax at the prescribed
rate; subject to percentage tax and will file the required percentage tax returns or subject to withholding
percentage tax, in case of government money payments.

 Eight Percent (8%) income tax rate under Section 24(A)(2)(b) of the Tax Code, as amended, based on gross
receipts/sales and other non-operating income - with this selection, I understand that this is in lieu of the
graduated income tax rates and the Percentage Tax under Section 116 of the Tax Code, as amended; thus,
only the creditable income withholding tax based on the prescribed rate shall be made;

13. That based on my selection above, if my gross sales/receipts and other non-operating income exceeds ₱3,000,000, my income
payor /withholding agents shall automatically withhold the higher rate of withholding of ten percent (10%) in the case of
income items with two (2) prescribed creditable withholding tax rate depending on the total amount of income payment
received:

e. In case of Graduated Income Tax Rates, I acknowledge that aside from income tax, I am subject to business
tax (VAT) unless expressly exempted; and consequently subject to withholding of income. Moreover, if the
payor is a government entity, business tax withholding applies; OR

f. In case of Eight Percent (8%) income tax rate, I acknowledge that I am no longer qualified to avail of this
option since my income exceeds ₱3,000,000 and thus, the graduated income tax rates above shall
automatically apply together with the consequent liability for business tax/es;

14. That I duly execute this SWORN DECLARATION in compliance with the requirement prescribed under Section ____ of
Revenue Regulations No. ________;

15. That I declare, under the penalties of perjury, that this declaration has been made in good faith, and to the best of my knowledge
and belief to be true and correct.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at ___________, Philippines

_____________________________________________
Signature over Printed Name of Individual Taxpayer

SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in _______________________________.
Applicant exhibited to me his/her ___________________________issued at _______________________ on _________________________.
(Government Issued ID and No.)

NOTARY PUBLIC
Doc. No.: __________
Page No.: __________
Book No.: __________
Series of ___________

Affix ₱30.00
Documentary
Stamp Tax

(To be filled-out by the withholding agent/lone payor)

Date Received: __________________ Received by:

(MM-DD-YYYY-00001)
_____________________________________________________________
Signature over Printed Name of the Withholding Agent/Payor or Authorized Officer

_____________________________________________________________
Designation/Position of Authorized Officer

_____________________________________________________________
Name of Withholding Agent/Lone Payor
 ANNEX “B-2”

INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES

(For Self-Employed and/or Engaged in the Practice of Profession with Lone Income Payor)

I, _________________________________________________, ___________________________, of legal age, single/ married to

(Name) (Citizenship)
_____________________________________________________ permanently residing at _________________________________
(Name of Spouse)
____________________________________________________________________________________________________________ with
(Address)
Taxpayer Identification Number (TIN) __________________________________, after having been duly sworn in accordance with law

hereby depose and state:

16. That I derived my ______________________ income only from ________________________________________________

(business/professional) (Name of Lone Payor)
with Taxpayer Identification Number ___________________ and business address at _____________________________

____________________________________________________________________________________________________;

17. That for the current year ________, my gross receipts will not exceed Two Hundred Fifty Thousand Pesos (₱250,000.00) and
that I am registered as a non-VAT taxpayer; that whatever is the amount of income received, I will comply with the requirement
to file my Income Tax Return on the prescribed due date. For this purpose, I opt to avail of either one of the following:

 Graduated Income Tax Rates under Section 24(A)(2)(a) of the Tax Code, as amended, based on the taxable
income. With this selection, I acknowledge that I am subject to 0% income tax, thus, not subject to creditable
withholding tax; subject to percentage tax, if applicable, and will file the required percentage tax returns or
subject to withholding percentage tax, in case of government money payments.

 Eight Percent (8%) income tax rate under Section 24(A)(2)(b) of the Tax Code, as amended, based on gross
receipts/sales and other non-operating income - with this selection, I understand that this is in lieu of the
graduated income tax rates and the Percentage Tax under Section 116 of the Tax Code, as amended; thus,
no withholding tax shall be made;

18. That based on my selection above, if my gross sales/receipts and other non-operating income exceeds ₱250,000.00 but not over
₱3,000,000.00, my afore-stated lone income payor shall automatically withhold the prescribed rate of withholding tax:

g. In case of Graduated Income Tax Rates, I acknowledge that aside from income tax, I am subject to business
tax (Percentage Tax, if applicable) and creditable withholding of income in excess of P250,000.00, and
business tax withholding, if any, are applicable on the entire income payment; OR

h. In case of Eight Percent (8%) income tax rate, I acknowledge that I am only subject to income tax and thus,
to the creditable withholding income tax in excess of P250,000.00;

19. That I duly execute this SWORN DECLARATION in compliance with the requirement prescribed under Section ____ of
Revenue Regulations No. ________;

20. That I declare, under the penalties of perjury, that this declaration has been made in good faith, and to the best of my knowledge
and belief to be true and correct.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at ___________, Philippines

_____________________________________________
Signature over Printed Name of Individual Taxpayer

SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in _______________________________.
Applicant exhibited to me his/her ___________________________issued at _______________________ on _________________________.
(Government Issued ID and No.)

NOTARY PUBLIC
Doc. No.: __________
Page No.: __________
Book No.: __________
Series of ___________

Affix ₱30.00
Documentary
Stamp Tax

(To be filled-out by the withholding agent/lone payor)

Date Received: __________________ Received by:

(MM-DD-YYYY-00001)
_____________________________________________________________
Signature over Printed Name of the Withholding Agent/Payor or Authorized Officer

_____________________________________________________________
Designation/Position of Authorized Officer

_____________________________________________________________
Name of Withholding Agent/Lone Payor