Republic of the Philippines

For BIR BCS/ Department of Finance

Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Compensation
2316
January 2018 (ENCS)
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld 2316 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Year 2 For the Period
(YYYY)
2 0 2 0 From (MM/DD) 0 1 0 1 To (MM/DD) 1 2 3 1
Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer
3 TIN
474 - 010 - 827 - 0 0 0 0 0 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount

4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code 27 Basic Salary (including the exempt P250,000 & below)
or the Statutory Minimum Wage of the MWE 92, 914.00
DOMALANTA, ANTONETTE CONTRERAS
6 Registered Address 6A ZIP Code
28 Holiday Pay (MWE) 4, 205. 00
BATANG, INFANTA, PANGASINAN 2412 29 Overtime Pay (MWE) 15, 630.00
6B Local Home Address 6C ZIP Code
BATANG, INFANTA, PANGASINAN 2412 30 Night Shift Differential (MWE) 1,563.00
6D Foreign Address
31 Hazard Pay (MWE) 36,000.00
32 13th Month Pay and Other Benefits
7 Date of Birth (MM/DD/YYYY) 8 Contact Number (maximum of P90,000) 10,409.00
12 27 1995 0930-166-3989 33 De Minimis Benefits 30,000.00
9 Statutory Minimum Wage rate per day 280. 30 34 SSS, GSIS, PHIC & PAG-IBIG Contributions
and Union Dues (Employee share only) 7,994.00
10 Statutory Minimum Wage rate per month 8,409.00
Minimum Wage Earner (MWE) whose compensation is exempt from
35 Salaries and Other Forms of Compensation 24,000.00
11 x withholding tax and not subject to income tax 36 Total Non-Taxable/Exempt Compensation
Part II - Employer Information (Present) Income (Sum of Items 27 to 35) 222,715.00
12 TIN
555 - 444 - 333 - 00000 B. TAXABLE COMPENSATION INCOME REGULAR

13 Employer's Name
37 Basic Salary
REPUBLIKA CEMENT MANUFACTURING
14 Registered Address 14A ZIP Code 38 Representation

BATANG, INFANTA, PANGASINAN 2412 39 Transportation

15 Type of Employer
x Main Employer Secondary Employer
40 Cost of Living Allowance (COLA)
Part III - Employer Information (Previous)
16 TIN
- - - 41 Fixed Housing Allowance

17 Employer's Name 42 Others (specify)

42A
18 Registered Address 18A ZIP Code
42B
SUPPLEMENTARY
Part IVA - Summary
43 Commission
19 Gross Compensation Income from Present 16,000.00
Employer (Sum of Items 36 and 50) 248,715.00
44 Profit Sharing
20 Less: Total Non-Taxable/Exempt Compensation 10,000.00
Income from Present Employer (From Item 36) 222,715.00
45 Fees Including Director's Fees
21 Taxable Compensation Income from Present
Employer (Item 19 Less Item 20) (From Item 50) 26,000.00
46 Taxable 13th Month Benefits
22 Add: Taxable Compensation Income from
Previous Employer, if applicable 0
47 Hazard Pay
23 Gross Taxable Compensation Income
(Sum of Items 21 and 22) 26,000.00
48 Overtime Pay
24 Tax Due 0 49 Others (specify)
25 Amount of Taxes Withheld
25A Present Employer 0 49A

25B Previous Employer, if applicable 49B

0
26 Total Amount of Taxes Withheld as adjusted 50 Total Taxable Compensation Income
(Sum of Items 25A and 25B) 0 (Sum of Items 37 to 49B) 26,000.00
I/We declare, under the penalties of perjury that this certificate has been made in good faith, verified by me/us, and to the best of my/our knowledge and belief, is true and correct, pursuant
the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, I/we give my/our consent to the processing of my/our informati
as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

51 Date Signed
Present Employer/Authorized Agent Signature over Printed Name
CONFORME:
52 Date Signed
Employee Signature over Printed Name Amount paid, if CTC
CTC/Valid ID No. Place of
Date Issued
of Employee Issue
To be accomplished under substituted filing
I declare, under the penalties of perjury that the information herein stated are I declare, under the penalties of perjury that I am qualified under substituted filing of Income Tax Return
reported under BIR Form No. 1604-C which has been filed with the Bureau of (BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines
Internal Revenue. for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that
the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR
Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions
53 of Revenue Regulations (RR) No. 3-2002, as amended.
Present Employer/Authorized Agent Signature over Printed Name
(Head of Accounting/Human Resource or Authorized Representative) 54 ANTONETTE C. DOMALANTA
 Employee Signature over Printed Name
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Compensation
2316
January 2018 (ENCS)
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld 2316 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Year 2 For the Period
(YYYY)
2 0 2 1 From (MM/DD) 0 1 0 1 To (MM/DD) 1 2 3 1
Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer
3 TIN
987 - 654 - 321 - 0 0 0 0 0 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount

4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code 27 Basic Salary (including the exempt P250,000 & below)
or the Statutory Minimum Wage of the MWE 0.00
DOMALANTA, ANTONETTE CONTRERAS
6 Registered Address 6A ZIP Code
28 Holiday Pay (MWE) 0.00
BAGONG BAYAN, EL NIDO, PALAWAN 5313 29 Overtime Pay (MWE) 0.00
6B Local Home Address 6C ZIP Code
BAGONG BAYAN, EL NIDO, PALAWAN 5313 30 Night Shift Differential (MWE) 0.00
6D Foreign Address
31 Hazard Pay (MWE) 0.00
32 13th Month Pay and Other Benefits
7 Date of Birth (MM/DD/YYYY) 8 Contact Number (maximum of P90,000) 90,000.00
12 27 1995 0930-166-3989 33 De Minimis Benefits 0.00
9 Statutory Minimum Wage rate per day 34 SSS, GSIS, PHIC & PAG-IBIG Contributions
and Union Dues (Employee share only) 21,900.00
10 Statutory Minimum Wage rate per month
Minimum Wage Earner (MWE) whose compensation is exempt from
35 Salaries and Other Forms of Compensation 0.00
11
withholding tax and not subject to income tax 36 Total Non-Taxable/Exempt Compensation
Part II - Employer Information (Present) Income (Sum of Items 27 to 35) 111,900.00
12 TIN
123 - 456 - 789 - 00000 B. TAXABLE COMPENSATION INCOME REGULAR

13 Employer's Name
XYZ CORPORATION
37 Basic Salary 458,100.00
38 Representation
14 Registered Address 14A ZIP Code 0.00
BAGONG BAYAN, EL NIDO, PALAWAN 5313 39 Transportation 0.00
15 Type of Employer
X Main Employer Secondary Employer
Part III - Employer Information (Previous)
40 Cost of Living Allowance (COLA) 0.00
16 TIN
- - - 41 Fixed Housing Allowance 0.00
17 Employer's Name 42 Others (specify)
42A 0.00
18 Registered Address 18A ZIP Code
42B 0.00
SUPPLEMENTARY
Part IVA - Summary
43 Commission
19 Gross Compensation Income from Present 0.00
Employer (Sum of Items 36 and 50) 612,000.00
44 Profit Sharing
20 Less: Total Non-Taxable/Exempt Compensation 0.00
Income from Present Employer (From Item 36) 111,900.00
45 Fees Including Director's Fees
21 Taxable Compensation Income from Present 0.00
Employer (Item 19 Less Item 20) (From Item 50) 500,100.00
46 Taxable 13th Month Benefits
22 Add: Taxable Compensation Income from 0.00
Previous Employer, if applicable 0.00
47 Hazard Pay
23 Gross Taxable Compensation Income 0.00
(Sum of Items 21 and 22) 500,100.00
48 Overtime Pay
20,000.00
24 Tax Due 55,025.00 49 Others (specify)
25 Amount of Taxes Withheld
25A Present Employer 0.00 49A NIGHT-SHIFT DIFFERENTIAL PAY
2,000.00
25B Previous Employer, if applicable 49B
0.00 BONUS 20,000.00
26 Total Amount of Taxes Withheld as adjusted 50 Total Taxable Compensation Income
(Sum of Items 25A and 25B) 55,025.00 (Sum of Items 37 to 49B) 500,100.00
I/We declare, under the penalties of perjury that this certificate has been made in good faith, verified by me/us, and to the best of my/our knowledge and belief, is true and correct, pursuant
the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, I/we give my/our consent to the processing of my/our informati
as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

51 Date Signed
Present Employer/Authorized Agent Signature over Printed Name
CONFORME:
52 Date Signed
Employee Signature over Printed Name Amount paid, if CTC
CTC/Valid ID No. Place of
Date Issued
of Employee Issue
To be accomplished under substituted filing
I declare, under the penalties of perjury that the information herein stated are I declare, under the penalties of perjury that I am qualified under substituted filing of Income Tax Return
reported under BIR Form No. 1604-C which has been filed with the Bureau of (BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines
Internal Revenue. for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that
the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR
Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions
53 of Revenue Regulations (RR) No. 3-2002, as amended.
Present Employer/Authorized Agent Signature over Printed Name
(Head of Accounting/Human Resource or Authorized Representative) 54 ANTONETTE C. DOMALANTA
 Employee Signature over Printed Name
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Compensation
2316
January 2018 (ENCS)
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld 2316 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Year 2 For the Period
(YYYY)
2 0 2 0 From (MM/DD) 0 1 0 1 To (MM/DD) 1 2 3 1
Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer
3 TIN
474 - 010 - 827 - 0 0 0 0 0 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount

4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code 27 Basic Salary (including the exempt P250,000 & below)
DOMALANTA, ANTONETTE CONTRERAS or the Statutory Minimum Wage of the MWE

28 Holiday Pay (MWE)

6 Registered Address 6A ZIP Code
BATANG, INFANTA, PANGASINAN 2412 29 Overtime Pay (MWE)
6B Local Home Address 6C ZIP Code
30 Night Shift Differential (MWE)
BATANG, INFANTA, PANGASINAN 2412
6D Foreign Address
31 Hazard Pay (MWE)

32 13th Month Pay and Other Benefits

7 Date of Birth (MM/DD/YYYY) 8 Contact Number (maximum of P90,000) 90,000.00
12 27 1995 0930-166-3989 33 De Minimis Benefits 35,000.00
9 Statutory Minimum Wage rate per day 34 SSS, GSIS, PHIC & PAG-IBIG Contributions
and Union Dues (Employee share only) 26,400.00
10 Statutory Minimum Wage rate per month
35 Salaries and Other Forms of Compensation
Minimum Wage Earner (MWE) whose compensation is exempt from
11 x withholding tax and not subject to income tax 36 Total Non-Taxable/Exempt Compensation
Part II - Employer Information (Present) Income (Sum of Items 27 to 35) 151,400.00
12 TIN
555 - 444 - 333 - 00000 B. TAXABLE COMPENSATION INCOME REGULAR

13 Employer's Name
REPUBLIKA CEMENT MANUFACTURING
37 Basic Salary 453,600.00
14 Registered Address 14A ZIP Code 38 Representation

BATANG, INFANTA, PANGASINAN 2412 39 Transportation 36,000.00

15 Type of Employer
x Main Employer Secondary Employer
Part III - Employer Information (Previous)
40 Cost of Living Allowance (COLA) 48,000.00
16 TIN
- - - 41 Fixed Housing Allowance

17 Employer's Name 42 Others (specify)

42A
18 Registered Address 18A ZIP Code
42B
SUPPLEMENTARY
Part IVA - Summary
43 Commission
19 Gross Compensation Income from Present 23,000.00
Employer (Sum of Items 36 and 50) 873,786.00
44 Profit Sharing
20 Less: Total Non-Taxable/Exempt Compensation 42,000.00
Income from Present Employer (From Item 36) 151,400.00
45 Fees Including Director's Fees
21 Taxable Compensation Income from Present
Employer (Item 19 Less Item 20) (From Item 50) 722,386.00
46 Taxable 13th Month Benefits
22 Add: Taxable Compensation Income from 18,000.00
Previous Employer, if applicable 0
47 Hazard Pay
23 Gross Taxable Compensation Income
(Sum of Items 21 and 22) 722,386.00
48 Overtime Pay
74,351.00
24 Tax Due 110,596.00 49 Others (specify)
25 Amount of Taxes Withheld
25A Present Employer 90,096.00 49A
HOLIDAY PAY 20,000.00
25B Previous Employer, if applicable 49B
0 OVERTIME PAY 7,435.00
26 Total Amount of Taxes Withheld as adjusted 50 Total Taxable Compensation Income
(Sum of Items 25A and 25B) 90,096.00 (Sum of Items 37 to 49B) 722,386.00
I/We declare, under the penalties of perjury that this certificate has been made in good faith, verified by me/us, and to the best of my/our knowledge and belief, is true and correct, pursuant
the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, I/we give my/our consent to the processing of my/our informati
as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

51 Date Signed
Present Employer/Authorized Agent Signature over Printed Name
CONFORME:
52 Date Signed
Employee Signature over Printed Name Amount paid, if CTC
CTC/Valid ID No. Place of
Date Issued
of Employee Issue
To be accomplished under substituted filing
I declare, under the penalties of perjury that the information herein stated are I declare, under the penalties of perjury that I am qualified under substituted filing of Income Tax Return
reported under BIR Form No. 1604-C which has been filed with the Bureau of (BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines
Internal Revenue. for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that
the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR
Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions
53 of Revenue Regulations (RR) No. 3-2002, as amended.
Present Employer/Authorized Agent Signature over Printed Name
(Head of Accounting/Human Resource or Authorized Representative) 54 ANTONETTE C. DOMALANTA
 Employee Signature over Printed Name
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Compensation
2316
January 2018 (ENCS)
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld 2316 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Year 2 For the Period
(YYYY)
2 0 2 0 From (MM/DD) 0 1 0 1 To (MM/DD) 1 2 3 1
Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer
3 TIN
987 - 654 - 321 - 0 0 0 0 0 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount

4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code 27 Basic Salary (including the exempt P250,000 & below)
or the Statutory Minimum Wage of the MWE 0.00
DOMALANTA, ANTONETTE CONTRERAS
6 Registered Address 6A ZIP Code
28 Holiday Pay (MWE) 0.00
BAGONG BAYAN, EL NIDO, PALAWAN 5313 29 Overtime Pay (MWE) 0.00
6B Local Home Address 6C ZIP Code
BAGONG BAYAN, EL NIDO, PALAWAN 5313 30 Night Shift Differential (MWE) 0.00
6D Foreign Address
31 Hazard Pay (MWE) 0.00
32 13th Month Pay and Other Benefits
7 Date of Birth (MM/DD/YYYY) 8 Contact Number (maximum of P90,000) 90,000.00
12 27 1995 0930-166-3989 33 De Minimis Benefits 6,000.00
9 Statutory Minimum Wage rate per day 34 SSS, GSIS, PHIC & PAG-IBIG Contributions
and Union Dues (Employee share only) 17,100.00
10 Statutory Minimum Wage rate per month
Minimum Wage Earner (MWE) whose compensation is exempt from
35 Salaries and Other Forms of Compensation 0.00
11 x withholding tax and not subject to income tax 36 Total Non-Taxable/Exempt Compensation
Part II - Employer Information (Present) Income (Sum of Items 27 to 35) 113,100.00
12 TIN
123 - 123 - 123 - 00000 B. TAXABLE COMPENSATION INCOME REGULAR

13 Employer's Name
BETTER EVERYDAY CORPORATION
37 Basic Salary 402,900.00
38 Representation
14 Registered Address 14A ZIP Code 0.00
ESPANA, SAMPALOC, MANILA 029 39 Transportation 12,000.00
15 Type of Employer
x Main Employer Secondary Employer
Part III - Employer Information (Previous)
40 Cost of Living Allowance (COLA) 24,000.00
16 TIN
- - - 41 Fixed Housing Allowance 0.00
17 Employer's Name 42 Others (specify)
42A 0.00
18 Registered Address 18A ZIP Code
42B 0.00
SUPPLEMENTARY
Part IVA - Summary
43 Commission
19 Gross Compensation Income from Present 0.00
Employer (Sum of Items 36 and 50) 636,000.00
44 Profit Sharing
20 Less: Total Non-Taxable/Exempt Compensation 0.00
Income from Present Employer (From Item 36) 113,100.00
45 Fees Including Director's Fees
21 Taxable Compensation Income from Present 0.00
Employer (Item 19 Less Item 20) (From Item 50) 522,900.00
46 Taxable 13th Month Benefits
22 Add: Taxable Compensation Income from 32,000.00
Previous Employer, if applicable 0.00
47 Hazard Pay
23 Gross Taxable Compensation Income 0.00
(Sum of Items 21 and 22) 522,900.00
48 Overtime Pay
20,000.00
24 Tax Due 60,725.00 49 Others (specify)
25 Amount of Taxes Withheld
25A Present Employer 60,725.00 49A NIGHT-SHIFT DIFFERENTIAL PAY
12,000.00
25B Previous Employer, if applicable 49B
0 BONUS 20,000.00
26 Total Amount of Taxes Withheld as adjusted 50 Total Taxable Compensation Income
(Sum of Items 25A and 25B) 60,725.00 (Sum of Items 37 to 49B) 522,900.00
I/We declare, under the penalties of perjury that this certificate has been made in good faith, verified by me/us, and to the best of my/our knowledge and belief, is true and correct, pursuant
the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, I/we give my/our consent to the processing of my/our informati
as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

51 Date Signed
Present Employer/Authorized Agent Signature over Printed Name
CONFORME:
52 Date Signed
Employee Signature over Printed Name Amount paid, if CTC
CTC/Valid ID No. Place of
Date Issued
of Employee Issue
To be accomplished under substituted filing
I declare, under the penalties of perjury that the information herein stated are I declare, under the penalties of perjury that I am qualified under substituted filing of Income Tax Return
reported under BIR Form No. 1604-C which has been filed with the Bureau of (BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines
Internal Revenue. for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that
the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR
Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions
53 of Revenue Regulations (RR) No. 3-2002, as amended.
Present Employer/Authorized Agent Signature over Printed Name
(Head of Accounting/Human Resource or Authorized Representative) 54 ANTONETTE C. DOMALANTA
 Employee Signature over Printed Name
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Compensation
2316
January 2018 (ENCS)
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld 2316 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Year 2 For the Period
(YYYY)
2 0 2 1 From (MM/DD) 0 1 0 1 To (MM/DD) 1 2 3 1
Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer
3 TIN
474 - 010 - 827 - 0 0 0 0 0 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount

4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code 27 Basic Salary (including the exempt P250,000 & below)
or the Statutory Minimum Wage of the MWE 0.00
DOMALANTA, ANTONETTE CONTRERAS
6 Registered Address 6A ZIP Code
28 Holiday Pay (MWE) 0.00
BATANG, INFANTA, PANGASINAN 2412 29 Overtime Pay (MWE) 0.00
6B Local Home Address 6C ZIP Code
BATANG, INFANTA, PANGASINAN 2412 30 Night Shift Differential (MWE) 0.00
6D Foreign Address
31 Hazard Pay (MWE) 0.00
32 13th Month Pay and Other Benefits
7 Date of Birth (MM/DD/YYYY) 8 Contact Number (maximum of P90,000) 90,000.00
12 27 1995 0930-166-3989 33 De Minimis Benefits 6,000.00
9 Statutory Minimum Wage rate per day 34 SSS, GSIS, PHIC & PAG-IBIG Contributions
and Union Dues (Employee share only) 21,000.00
10 Statutory Minimum Wage rate per month
Minimum Wage Earner (MWE) whose compensation is exempt from
35 Salaries and Other Forms of Compensation 0.00
11 x withholding tax and not subject to income tax 36 Total Non-Taxable/Exempt Compensation
Part II - Employer Information (Present) Income (Sum of Items 27 to 35) 117,000.00
12 TIN
123 - 123 - 123 - 00000 B. TAXABLE COMPENSATION INCOME REGULAR

13 Employer's Name
BETTER EVERYDAY CORPORATION
37 Basic Salary 399,000.00
38 Representation
14 Registered Address 14A ZIP Code 0.00
ESPANA, SAMPALOC, MANILA 029 39 Transportation 12,000.00
15 Type of Employer
x Main Employer Secondary Employer
Part III - Employer Information (Previous)
40 Cost of Living Allowance (COLA) 24,000.00
16 TIN
- - - 41 Fixed Housing Allowance 0.00
17 Employer's Name 42 Others (specify)
42A 0.00
18 Registered Address 18A ZIP Code
42B 0.00
SUPPLEMENTARY
Part IVA - Summary
43 Commission
19 Gross Compensation Income from Present 0.00
Employer (Sum of Items 36 and 50) 636,000.00
44 Profit Sharing
20 Less: Total Non-Taxable/Exempt Compensation 0.00
Income from Present Employer (From Item 36) 117,000.00
45 Fees Including Director's Fees
21 Taxable Compensation Income from Present 0.00
Employer (Item 19 Less Item 20) (From Item 50) 519,000.00
46 Taxable 13th Month Benefits
22 Add: Taxable Compensation Income from 32,000.00
Previous Employer, if applicable 0.00
47 Hazard Pay
23 Gross Taxable Compensation Income 0.00
(Sum of Items 21 and 22) 519,000.00
48 Overtime Pay
20,000.00
24 Tax Due 59,750.00 49 Others (specify)
25 Amount of Taxes Withheld
25A Present Employer 59,750.00 49A NIGHT-SHIFT DIFFERENTIAL PAY
12,000.00
25B Previous Employer, if applicable 49B
0 BONUS 20,000.00
26 Total Amount of Taxes Withheld as adjusted 50 Total Taxable Compensation Income
(Sum of Items 25A and 25B) 59,750.00 (Sum of Items 37 to 49B) 519,000.00
I/We declare, under the penalties of perjury that this certificate has been made in good faith, verified by me/us, and to the best of my/our knowledge and belief, is true and correct, pursuant
the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, I/we give my/our consent to the processing of my/our informati
as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

51 Date Signed
Present Employer/Authorized Agent Signature over Printed Name
CONFORME:
52 Date Signed
Employee Signature over Printed Name Amount paid, if CTC
CTC/Valid ID No. Place of
Date Issued
of Employee Issue
To be accomplished under substituted filing
I declare, under the penalties of perjury that the information herein stated are I declare, under the penalties of perjury that I am qualified under substituted filing of Income Tax Return
reported under BIR Form No. 1604-C which has been filed with the Bureau of (BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines
Internal Revenue. for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that
the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR
Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions
53 of Revenue Regulations (RR) No. 3-2002, as amended.
Present Employer/Authorized Agent Signature over Printed Name
(Head of Accounting/Human Resource or Authorized Representative) 54 ANTONETTE C. DOMALANTA
 Employee Signature over Printed Name
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)