DR. DENNIS P.

IMPERIO
1ST QTR 2019

NO TIN NUMBER H.M.O. JAN

230-586-355-001 BOROUGH MEDICAL CARE INSTITUTE, INC. 13,125.00
004-628-891-000 CARITAS HEALTH SHIELD, INC. 43,058.22
TOTAL 56,183.22
 FEB MAR TOTAL % W/TAX
16,800.00 23,292.50 53,217.50 10% 5,321.75
104,814.67 - 147,872.89 10% 14,787.29
121,614.67 23,292.50 201,090.39 20,109.04
 DENNIS P. IMPERIO
PHYSICIAN
CLINICA CARITAS 8TH FLR. TIMES BUILDING CALLEJON TIBOK COR. UN
TIN NO: 220-107-486-000
SUMMARY ALPHALIST OF WITHHOLDING AGENTS OF INCOME PAYMENTS SUB
From JANUARY 01 - MARCH 31, 2

SEQ TIN REGISTERED NAME

INCLUDING BRANCH CODE (ALPHALIST)

1 230-586-355-001 BOROUGH MEDICAL CARE INSTITUTE, INC.

2 004-628-891-000 CARITAS HEALTH SHIELD, INC.

I declare under the penalties of perjury, that this certificate has been made in good faith, verified by m
the NIRC, and regulations issued under the authority thereof, that the information contained herein completely
(BIR form No. 2307) issued by the payor, that the income payments has been declared part of the gross income
earned or received that, the information appearing herein is consisted with the information contained in the Ce
the claim for refund/tax credit.
 DENNIS P. IMPERIO
PHYSICIAN
NG CALLEJON TIBOK COR. UN AVE., BRGY 666 ZONE 072 ERMITA, MANILA
TIN NO: 220-107-486-000
S OF INCOME PAYMENTS SUBJECTED TO WITHHOLDING TAX AT SOURCE (SAWT)
om JANUARY 01 - MARCH 31, 2019

RETURN RETURN NATURE OF AMOUNT TAX

PERIOD INCOME
PERIOD TO ATC PAYMENT TAX BASE RATE
FROM MM/DD/YY
MM/DD/YY
1/1/2019 3/31/2019 IT PROF FEE 53,217.50 10%
1/1/2019 3/31/2019 IT PROF FEE 147,872.89 10%

TOTAL 201,090.39

made in good faith, verified by me, and to the best of knowledge and belief , is true and correct pursuant to the provisio
ion contained herein completely reflects a summary of information on all Certificates of Creditable Withholding Tax at
declared part of the gross income/receipt in the our Income Tax/Vat/Percentage Tax Returns where the taxable income w
information contained in the Certificate of Tax Withheld at Source and that, inconsistent information shall result to deni

_____________________________________________
DENNIS P. IMPERIO
Taxpayer/Authorized Representative
WT)

TAX

WITH

5,321.75
14,787.29

20,109.04

and correct pursuant to the provisio

s of Creditable Withholding Tax at
Returns where the taxable income w
stent information shall result to deni

_______________________________
DENNIS P. IMPERIO
er/Authorized Representative
 DENNIS P. IMPERIO
PHYSICIAN
CLINICA CARITAS 8TH FLR. TIMES BUILDING CALLEJON TIBOK COR. UN
TIN NO: 220-107-486-000
SUMMARY ALPHALIST OF WITHHOLDING AGENTS OF INCOME PAYMENTS SUB
From JULY 01 - SEPTEMBER 30, 2

SEQ TIN REGISTERED NAME

INCLUDING BRANCH CODE (ALPHALIST)

1 230-586-355-001 BOROUGH MEDICAL CARE INSTITUTE, INC.

2 004-628-891-000 CARITAS HEALTH SHIELD, INC.

I declare under the penalties of perjury, that this certificate has been made in good faith, verified by m
the NIRC, and regulations issued under the authority thereof, that the information contained herein completely
(BIR form No. 2307) issued by the payor, that the income payments has been declared part of the gross income
earned or received that, the information appearing herein is consisted with the information contained in the Ce
the claim for refund/tax credit.
 DENNIS P. IMPERIO
PHYSICIAN
NG CALLEJON TIBOK COR. UN AVE., BRGY 666 ZONE 072 ERMITA, MANILA
TIN NO: 220-107-486-000
S OF INCOME PAYMENTS SUBJECTED TO WITHHOLDING TAX AT SOURCE (SAWT)
rom JULY 01 - SEPTEMBER 30, 2019

RETURN RETURN NATURE OF AMOUNT TAX

PERIOD INCOME
PERIOD TO ATC PAYMENT TAX BASE RATE
FROM MM/DD/YY
MM/DD/YY
7/1/2019 9/30/2019 IT PROF FEE 90,737.50 10%
7/1/2019 9/30/2019 IT PROF FEE 221,482.57 10%

TOTAL 312,220.07

made in good faith, verified by me, and to the best of knowledge and belief , is true and correct pursuant to the provisio
ion contained herein completely reflects a summary of information on all Certificates of Creditable Withholding Tax at
declared part of the gross income/receipt in the our Income Tax/Vat/Percentage Tax Returns where the taxable income w
information contained in the Certificate of Tax Withheld at Source and that, inconsistent information shall result to deni

_____________________________________________
DENNIS P. IMPERIO
Taxpayer/Authorized Representative
WT)

TAX

WITH

9,073.75
22,148.26

31,222.01

and correct pursuant to the provisio

s of Creditable Withholding Tax at
Returns where the taxable income w
stent information shall result to deni

_______________________________
DENNIS P. IMPERIO
er/Authorized Representative