Republic of the Philippines

For BIR BCSI ,€4"'', Departm€nt of Finance

Use, Only ltem: Bureau of lnternal Revenue
BIR Form No.
Annual lncome Tax Return
1 700 lndividuals Earning Purely Gompensation lncome
(lncluding Non-BusinesslNon-Profession lncome)
January 20'18 (ENCS)
Page 1
Enter all required information in CAPITAL LEIIERS using BLACK ink. Mark applicable boxes
with an 'X". Tlzree (3) copies must be filed: two (2) copies for BIR and one copv fa( ttle taxoaver.
IIII[fitlilHlltfii[ffillll 1 7()O O1/lBENCS P1

1 For the Year (i"/Y'4 21012 2AnrendedReturn? I - Yes ,i ruo 3 Alphanumeric Tax Code (ATCJ Irl 0 11
11
Part I - Backqround lnformation on TaxpayerlFil6r
4 N il 5 RDO 6 Type
Employee NRANETB-
1 I 3 4 5 6 7 B I 0 0 0 0 0 3 2
{Regular Rates) i25%)
7 Taxpayer's Nanle 4asl |,lane, First l',lamc, I'ticldle Name)

DrArDrUiL rL rA rM,ArR, I ,A,N rN rE , ,S,UrA rR r ErZ l I I J I I I l

8 Req iSteredAddress ikrrlialecamgtelealdress.flhreghleedakiessiaeltfemthmhecurn!aktes.gabtuRTttouprklergisterettaldressb'lusingElRFomMLlgt)St

l l

I I r r{fr I-li'F,Pi u\
I
c
I I I I I I I I I l I I I I I
8A ZIP Code 111 11 16
9 Date of Bidh (Mht/DD/yYYY)10 Email Address
or3 25 2tAtOt2 D1,A1DrUtLrLlA1M1AlR l1A;NrNrEr@rGtMrA1llLl 1C;O1M1 | I i I I I

11 Citizenship 12 Claiminq Forejqn Tax Credits? 13 Foreiqn Tax Number, if applicable

F L IrP I N o l
'/es . x No
L.i
15 Civil Status
::
+ 6 a,o
vlr 4 5 6 1211 0 6 2t1 x Single Married Legally Separated Widowler
16 lf manied, spcuse has income? Yes No 17 Filing Status fl Joini Filing l--l Separate Filing

Part ll - Background lnformation on Spouse

18 TIN 19 RDO Code 20 Taxpayer Type
0 0 0 0 0
Employee
' -, (Regular Rates)
NRANETB-

Name Fkst Middle

I I l l l

22 Contact Number 23 Citizenship

I
j I I II lt I

24 Claiming Foreign Tax Credits? Yes x No 25 Foreion Tax Nurnber

I
tttllttttltlttll
: Part lll - Total Tax Payable ';t {DO NOT wfu Mavos; I Mr6 q Lcis *opdBa; * 6 ffi wtd W
Particulars
26 Tax Due (Either from Paft V.A rbm 47NB OR cai y.g 53AJr1 {tz5o I

27 Less: Total Tax Credits/Paymenls fron Part V.C ltern 58A/B)

oo
3tzsD
28 Net Tax Payable/(Overpayment) {ttern ?6 Le$s ttem 27) (From Patt V uem 59A/B) I I i+ffi't' I I I I I

29 Less: Porlion of Tax Payable Allower.i for 2'' lnstallmenl to be oaid on or before October 'l5
{5004 or less of ltem 261 {aDolicable onlv to enblovee subiecl to reoular lT ratesj I I I I l I l I I I I I
I

30 Amounl of Tax Payablei(Overpayment) {ltem 2B Less ttefi 29)

r t tL-W-*i5-6 ttt III
Acid: Penalties 31 Sur^charge
I
32 Interest I I I i I l I I I I

33 Compromise itl ttl

34 Total Penalties (Sum of ttens 31 to 33)
rr t]13T-fT5t0 i I I I
35 Total Amount Payablelioverpayment) (Sum of jtems 30 and 34)
lttitlr tl
36 Aggregate Amount Payable/{Overpayment) (Sun of ttems 35A anct 35a)
I declare unde, the penallies of peluty that fhr's and ai! ,rs It me, lo ny are true i.:alrect,
to lhe pioyisiofis o{ lhe Nalior)ai tnternal Revenue Code. as afiended. anii lhe regulations issUed under authotity thercc{. Further, give ny consenf to lhe pficessing of my infoffiafiofi as
at Adlhoized indicate fl{ and attach ad\oozalion

37 Number of Attachmenls

Part lV . Details of Payment

Particulars Drawee Amount
38 Cash/Bank Debit Memo
I I I i I I I I l I I I I lt
39 Check
I I l I l I I l I l l I I I I I I I

Tax Debit f\Iemo I

ltltl llltlttltt ltl

l\,'lachine ValidationiRevenue Official Receipt Delails [if not filed with an Althotized Agent Bank {AAB)] Stamp of P,eceiving Office/AAB and Date of Receipt
(RO's SignatureBank Tellp/'s lnitial)

NOTE: * Non-Resident Alien Not Engaged in Trade or Business

"- The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)
 BIR Form No,

1 700 Annual lncome Tax Return

January 2018 (ENCS)
Page 2
Individuals Earning Purely Compensation Income
(lncl uding Hon-BusinesslNon-Profession lncome) I I I I [Htl,1 tittlt0li18ENcs
'1700
lffi I r I ll
P2
I

1 t213s41 516r7 B 9,0,0,0,0,0 D1A1D1U1L1L1A1 I I I I I I I I I I I I I I I I r I

iirii

tf ta in items 42 to if tilt 00
Part V.A - $ubject to Graduated Rates
42 Gross Compensation lncome fFrom Schedule 1 lren ,Ac/sBc)
lttrttt I I I I I l I

43 Less: Non-Taxable / Exempt Compensation rlll

44 Gross Taxable Compensation lncome 1/tem 42 Les$ liem 43) illlltt llttltl
Itrtttt llttllt
t: i' :
46 Total Taxable lncome lsurn of ltens 44 anci 45)
i I I I I I l
rttt
47 Tax Due lksn 45 x Applicable lllco7e Tsx Rate (rcfe{ to tax table below)l (To Pa|t fil tlem 26)
ttrlttt Itttttt
to
48 Gross Compensation lncome (Frorr Schedule 1 ltem 5Ad/5Bd) t t5t1r0t0t0r0 tllittl
Less: Non-Taxable/Exempt {please specify)
I I
.lr{ b L, L) L)
I I l I

50 Gross Taxable Compensation lncome oten 4B Less ttem 49)

I t-+iffTtT0-TU-_ llttttl
51 Add: Other Taxable lncome @tease speciryt itttttt rtlrttt
52 Total Taxable Income (Sum of rtems 5o and 51)
IIIIIII itt ltl
53 Tax Due lttetn 52 x 25% Flat Rate) (To Part lll ltern 26)
ut L5 \)
tl I 7't 3n-7T5lT- tlttl

54 Tax Withheld per BIR Form No. 2316. if applicable (Frcm sclledule 1 ltem sAe/lae)
L I I I I I I

55 Tax Paid in Return Previously Filed, if this is an Amended Return lttttlt illll
56 Foreign Tax Credits, if applicable
tlttll
57 Other Tax {specify) tlLttlt tllllrt
..:
58 Totaf Tax CreditslPayments (Surn of ltems 54 to 57) (Ta Paft tli ltem 27) tlltlll ltttttt
59 Net Tax Payablel(Overpayfienl) Eithet ll.m 47 OR ltetn 53 less /telr 58) (Ta Part tli ltem 28) I
I I I I I I I I I I l I

Part Vl - Schedule
1-
*anfbehha,Etexlreefifuefl.*tfunSA.enle(tuTdalGtu$Coflxiens3liona/dTdalTaxWhlaldrtrtfrTu}awaldanltunSB.fo{ti.r-*xilsP-. ao iC NMe wnd uo)
li:i':ii a. Name of

Taxpayer PrAr-tMr lrNrEr tCtOtRrPrOtRtAtTrltOrNr I I I I I I I I I I I I I I I

Spouse
I I I I I I I I I l l I
b. Employer's TIN 9 rB r7 I 6l 5t 4t3t2t 1 t0 t0 t0 t0 I

I- i_-i
tarpayer ttttttttlttttttt lrtt I I I I I I I I I I I I I I

I I spouse Illtlltlllllllt b. Ernployer's TIN

rlttrtttttttl
Taxpayer tltlttttlttttttt tltt I I I I I I I I I I I I I I

Spouse
trtttrtrttrrrtr b. Employer's TIN
ltlttttllttll
|l Tr*oru"t
4 I_-] sporse
ltttttttttlttltt tttt I I I I I I I I I I I l

lttltlttttttltt b. Employer's TIN

rrttrtttttitl
Cantinuation of Schedule I linlet lhe atnauftf al compensalian and lax c, i , npensat on I icoere S-tllel t lncome
e. Tax Withheld
wilihek) co$escsndina la the abave englcver \ to Reoularicraduated Rates

1 PA-fu1INE IO O U Q
CORPORATION tlttlll I l5l'1 t0t0 0t0 I rffir++..*+O
2
I I I I I I I tltl!tt I I I I

rtttlrt tlltltl lttltt

4
I I I I I I I tlttltl I I I I I

sA Gross Compensation lncome and Total Tax Withheld for

TAXPAYER tlo PattV ltens 42A/48A ead 51Al I I I I I l I I l5L1l0l0l0t0 I t7 13 l7l 510
Gross Comoensatrcr lncome and Tctal Tax WithhelrJ ror
uU SPOUSE flo Parl y ltffis 428t488 and 54Bt I I I i I I I I I I I I I I I I I I I I

I I TAHI F
lf Taxable lncome s: Oue is: lf Taxable Income is: Tax Oue is:
Nol over P p ,5n ono
1er P 40rl fi00 .p 250 0llo Aver P )5t 1 iol" of th€ Exae-ss over P 25n 00fl
+ the OverP 400 not Bver a+ excesS
Ovcr P 8uC.000 bll flo P 130.000 + 30o/. o Over P 800 1 )0+: 5'llr oI ihc i)raetss over P 800,000
P 490.000 + 32ol" o the excess ova OverP2( 6.,,erP8000000 , of the excess ov6r P 2 000 000
F 2,410,000 + 35% c Over P 8,00( )00 0 i5-a1: of the excess over P 8,000,0C)0
For BIR ECSI
UsB Only Item:
ffi
\e7
Republrc of the Philippines
Department of Finance

BIR Form ND.

cate Compensation
2316
Januar,v 2018 tENCS}
Payment/Tax Withheld Illtffi
) 0 , 1 U I 0 1 1 2 1

1 2 J 4 q A B I 0 0

DADU L4ARIANI{E SUAREZ 0 3 2

REYESS-T.,€AMPAIOC, VrAN ILA T FLIfF 1 0 0

I 1 1 6
ilHl.;+

(naximxm 30,000 /
0 3 ) 5 2 0 0 I 0 I 4 5 6 2 1 0 6 2 1
De
t2aooo

30,000
Forff s of CornpeFsailorl

€.5oo O
I 7 6 5 4 3 1 0 0 0 0

fulINE CORPORATIONJ 3{5b o o

N. REYES ST., SAil,4PALOC, I,IANILA 1 0 0 o
'10,000

20,000

Olher berrefits

lrccme frolx
iSum 510,000

5r
Taxable
ilteln 19 i.e$$ lleat 5G; 4*fr6 \q 5F

21 and 22) 435,000

20,000
7A,Tst o 1

r0000 4SA Holiday Pay 10,000

25B

CoI]]pensalion !nccme
73,750 37 to 4'l5o oo

51 Dat6 Sign€d
EmployerlAuihcrrized over
I
j ttt

57 Date Signed o 14 2i2 214 1211

Name Amounl paid, if
lD Nc. Place af
PRC 200200 PASAY CITY Date l$sued 0 1 3 1 2 0 2 2

lhal am oudified uoder

reoortecj u.1der EiR No. has been filed wiih the Eureau of {BlE Foffi an* lnalme ircm ang the Plriiippioee
lniernal Revenue- for the calendary€ar; Itral laxeS have ihal
tlte 8lF. Fom No. 16{,1-C iihd by ill1 emdByerle the BJ?
Fom No. 2316 shall s6ryo the Eame Dlrp$e as il EIR Form No 17ffi has been ,led lusuant t0 the proyisioos
53 cf Revenue Hegulations (RR) No. 3-2002, * amendad.
Prcsent tnpl4'/pri qulhorizeC Aqent Signat-re Jier P- rteo tiare
1Hr.rd ol-Aruuunu-g.Hunrar Resouir e orAurhor.led qep psentali,c 54

The BIR wells