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2551Q Page 1 of 2
I declare, under the 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.
25____________________________________________________ 26_____________________________________
Signature over Printed Name of Taxpayer/ Title/Position of Signatory
Taxpayer Authorized Representative
______________________________________________________ _______________________________________
TIN of Tax Agent (if applicable) Tax Agent Accreditation No.(if applicable)
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BIR Form No. 2551Q Page 2 of 2
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
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