ERD.2.F.

002

REPUBLIC OF THE PHILIPPINES

Philippine Economic Zone Authority

Application No. _______

Date Filed___________

APPLICATION FOR EXTENSION OF INCOME TAX HOLIDAY

Under Art. 39(a) of EO 226

I. INFORMATION ABOUT APPLICANT

Applicant :
TIN No. :
Zone Location :
Official Representative :
Telephone No. :
Certificate of Registration No. :
Date of Registration :
Registered Activity :
(indicate date of Reg. Agreement or
Supplemental Agreement)

Status : ______ Pioneer _____ Non-Pioneer

Start of Commercial Operation (SCO)

Committed SCO (Per RA (SA)/PFS) :

Actual SCO (Certified by Zone

Administrator/Manager) :

Regular ITH Period: From __________ to _________

(mo./yr.) (mo./yr.)

Data on Past Availments

Previously Approved ITH Extension : NFEE ______ Period Covered :___________
CELR ______ Period Covered : ___________
IRM ______ Period Covered : ___________

II. PERIOD APPLIED FOR EXTENSION

From ______________ to _____________
(mm/yy) (mm/yy)

III. CRITERIA USED (pls. check)

_____________ Capital Equipment to Labor Ratio

_____________ Net Foreign Exchange Earnings
_____________ Indigenous Raw Materials
IV. COMPLIANCE CRITERIA
(Fill appropriate line and attach supporting computation and documents as enumerated
in the attached list of documentary requirements)

a. Capital Equipment to Labor Ratio: $ ___________________ per worker

b. Net Foreign Exchange Earnings :

Year 1 Year 2 Year 3 Average

$________ $_________ $________ $ ________

c. Ratio of Cost of Indigenous Raw Materials to Total Raw Materials Cost

Average Ratio ________________%

All representations and supporting documents in this application are true and
correct.

Done in ____________________ this _______ day of __________________________

___________________________
APPLICANT

___________________________
Signature of Authorized Signatory

Printed Name: _____________________

Designation/Position:_______________

REPUBLIC OF THE PHILIPPINES

_________________________________)
_________________________________) S.S.

SUBCRIBED and SWORN to before me this ________________ day of _________

20 _____ in the ______________________________________________ affiant exhibited
to me his/her Resident Certificate No. _______________________ at __________________
on ________________________ 20_____.

__________________________
NOTARY PUBLIC

Doc. No. _________________ Until December 31, 20____

Page No. _________________ PTR No. _________________
Book No. _________________ Issued at ________________
Series of _________________ Issued on ________________

Application for Extension of Income Tax Holiday

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