BIR FORM NO.

0804 Annex A
LIST OF ASSETS
Domestic and Foreign
CONCEPION CARRIER AIR CONDITIONING COMPANY
(Name of Taxpayer)
As of December 31, 2019

Tax Identification Number (TIN): _________________ LA TVN No. _______________

Address: ____________________________________ Tax Type: _______________________
_____________________________________________ Taxable Year: ____________________

A. Used in Business

Value (in Philippine

Size/Area Classification Peso)
Reference
(No. of (e.g., (Cost, if acquired by
(OCT/TCT/
Units for Residential, purchase; zonal value
Type CCT No. and/or Location
Machinery Commercial, or fair market value,
Tax Declaration
and Agricultural, whichever is higher, if
No.)
Equipment) etc.) by inheritance or
donation)
Land
Real
Land and
Properties
Building
Others
Machinery
and
Equipment
(in detail)

Type/Nature
Account No. Name/Address of Bank Total Value
of Account
In Foreign In Pesos
Cash on Hand Currency
and in Bank

Total Collectible Amount

Type/Nature Name & Address of Debtor
In Foreign In Pesos
Currency

Receivables

Name/Address No. of Total Value

Type/Nature of Value per
of Issuing Shares/
Investment Share/Unit In Foreign
Investments Company Units In Pesos
Currency
in Stocks,
Bonds and
Other
Certificates
Page 1 of 3
 Annex A
Type of
Motor Motor and
Vehicle Engine Brand/Model Plate No./Registration No. Total Value
(Land, Air, Number
Water)

Type Nature and Description Physical Location Value

Other
Business
Assets

B. Personal

Value (in Philippine

Size/Area Classification Peso)
Reference
(No. of (e.g., (Cost, if acquired by
(OCT/TCT/
Units for Residential, purchase; zonal value
Type CCT No. and/or Location
Machinery Commercial, or fair market value,
Tax Declaration
and Agricultural, whichever is higher, if
No.)
Equipment) etc.) by inheritance or
donation)
Real
Land
Properties
Land and
Building
Others
(specify)

Type/Nature
Account No. Name/Address of Bank Total Value
of Account
In Foreign In Pesos
Cash on Hand Currency
and in Bank

Total Collectible Amount

Type/Nature Name & Address of Debtor
In Foreign In Pesos
Currency

Receivables

Page 2 of 3
 Annex A
Name/Address No. of Total Value
Type/Nature of Value per
of Issuing Shares/
Investment Share/Unit In Foreign
Company Units In Pesos
Currency

Investments
in Stocks,
Bonds and
Other
Certificates

Type of
Motor Motor and
Vehicle Engine Brand/Model Plate No./Registration No. Total Value
(Land, Air, Number
Water)

Type Nature and Description Physical Location Value

Jewelry
Furnitures
Other Assets

Page 3 of 3