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Payment Slip Number


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Date
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Cash CJ Check D Bank Debit System
Account Name Branch Client Code Drawee Bank/Cash
BUREAU OF THE TREASURY- BIR
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TAX IDENTIFICATION Tax Type Form Type
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Revenue District Office Accounting Type (F/C} Teller's Validation
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500.00
0 I I 200.00 I I !Amount
100.00
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Reminder For Tax Payment thru LANDBANK Express Access Machine (LEAM)
20.00 enclosed cash tallieswith tne amount indicated in your payment slip. 1ne
COINS
countable for any discrepancy between the amount encoded in the machine
lly enclosed In the payment envelope.
TOTAL CASH PAYMENT
1•1*1ii#:t•J~f4C••JI
ACCOUNT NUMBER AMOUNT
BANK DEBIT ADVICE NUMBER
Signature Verified hy: Approved by: Posted by:
DEPOSITOR'S SIGNATURE
Revised May 2016
Taxpayer's Copy
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BIR Form No. Monthly Remittance Form
0619-E of Creditable Income Taxes WHhheld (Expanded)
January 2018
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QLANDBANK Date,(I \ \ C,
PaY,ment Slip Number
1 6496 ·9 48
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Please_(heck appropriate box BTR-BIR ACCOUNT NUMBER
IZJ Cash Check D Ba nk Debit System q
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Accou nt Name
Branch Client Code Drawee Bank/Cash
Ill
BUREAU OFTHE TREASU RY - BIR
10 101q IClk k Dt I
TAX IDENTIFICATION NUMBER Tax Type Form Type
I\J fil l d&l \ l~ lt.- 1
Revenue District Office Accounting Type (F/C) Teller's Validation
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Quarter No.(O, 1, 2, 3, or 4) Tax Period/Fiscal Year End-(mmddyy)
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AMOUNT Name of Bank/Branch
NO. OF PIECES DENOMINATION
PESOS I
CENTAVOS
I P 1,000.00 I I jCheck Number
500.00
0 200.00 Amou nt
.... 100.00
50.00
20.00
sea casn tallies witn tne amount lnC11cateC1 1n your payment slip. I ne
COINS able for any discrepancy between the amount encoded in the machine
closed in the payment envelope.
TOTAL CASH PAYMENT 1-J
BANK DEBIT ADVICE NUMBER ACCOU NT NUMBER AMOUNT
Signature Verifi ed by: Approved by: Posted by:
DEPOSITOR'S SIGNATURE
Taxpayer's Copy
Revised May 2016
htu Aaent'kt'raditation Nn.1 l I
Rapubbc of the PhUlppl,_.
Dapartmentof~
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BIRFonnNo.

0619-E
January 2018
Page 1
_1 For the MOrnn of ·
Monthly Remittance Form
of Creditable Income Taxes Withheld (Expanded)
&w .. _ _ ,,,,.,,,,,.,,, In CAPITAL LETTERS uu,g BLACK 1M. Af8flr
T\oo t:;CJD/a MUST be IIIIJd""" the BIR and OM ,_,by 11w T~....,ver.
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UNIT 2D, PRIFEL BUILDING, J . MIRANDA AVENUE, CONCEPCION PEQUENA, NAGA
CITY j_j~ _?!~~~~~-i 4 4 0 0

Part 11 _..; Tax Remittance


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Machine Validalion/Re,,e Official ReceipC Details (if not fll«I with 1111 Aulhorlad AQen1 Bani!,}

NOTE: •Please n,ad the BIR Data Privacy Policy found In the BIR website (www.blr.gov.ph)

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