BIR Form No.

Certificate of Creditable Tax

2307
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Withheld At Source September 2005 (ENCS)

1 For the Period 0 1 0 1 1 8 1 2 3 0 1 8

From (MM/DD/YY) To (MM/DD/YY)
Part I Payee Information
2 Taxpayer
4 8 1 5 3 1 1 0 0 0 0 0
Identification Number
3 Payee's Name JUBAY, JOHN ACE
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
4 Registered Address ZAMBOANGA CITY 4A Zip Code 7 0 0 0
5 Foreign Address 5A Zip Code

Payor Information
6 Taxpayer
0 0 0 7 9 1 4 6 4 0 1 1
Identification Number
7 Payor's Name DOH - CHD ZAMBOANGA PENINSULA
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
8 Registered Address UPPER CALARIAN, ZAMBOANGA CITY 8A Zip Code 7 0 0 0

PART II Details of Monthly Income Payments and Tax Withheld for the Quarter
Income Payments Subject to AMOUNT OF INCOME PAYMENTS
ATC
Expanded Withholding Tax 1st Month of 2nd Month of 3rd Month of Total Tax Withheld
the Quarter the Quarter the Quarter For the Quarter

EWT on Purchase of Services WI 120 Php 319,984.01 Php 3,441.51

Total Php 3,441.51

Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total Php -
We declare, under the penalties of perjury, that this certificate 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.

IRIS A. SANSON, CPA ACCOUNTANT III

Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory
(Signature Over Printed Name)

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
Conforme:

Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
(Signature Over Printed Name)

Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry