Forbin Bos! Gy Seratinen finance Use Ony_er CE urea oftnternal Revenue BIR Form No. Monthly Documentary Stamp Tax Declaration/Return 2000 January 2018 (ENCS) Page + ct A | 1 For the month of aawoovvry) ZAmended Retun? [_] Yes [_]No_|8 Number of Shoots Attached Partl - Background Information “4 Taxpayer entifcaton Number 7m) ode] T L 1 |SRDOCede | | | Tf 1 L Taxpayer's Name (aat Nar, Fst Nari, Mile Nam fr Individual OF Regitered Nara for Nona a "7 FagSTored AGGTESS Taina se Fone Wasa a wns tn Pa ce he oP OW a ena ya ea ‘Contact Nuniber arare iphone No] | @ Email ATGTESS rit poo ty [0 GinerPary tothe vansacion _[_] Credororgagoriote LL] Detiorongagestoe ma Cons Nano Caet Name Fret Name, Mila Name fr individual OR Ragitred Nara or Nonna bi bi prics iii is |PTN] iy biti fis Mode of fixture __L_] eDST System ___] Consiructve Affxure _L_] Loose Stamps Part l= Computation of Payable ‘A. For Electronie Documentary Stamp Tax (eDST) System and Constructive Affxture of Documentary Stamp 14 Tax Due forthe Month (From Schedule 1) Less: 15A Balance Carried Over from Previous Retum 4158 Payment thru Constructive Affxture (From School 2) *15C Advance Payment during the month (From Schoaue 3), 15D Total (Sum of oms 154 to 156) 16 Net Tax Payabe(Overpayment/Balance tobe carried over othe Next Return) lo 14125 om 160) [Add: Penalties 17A Surcharge 17 Interest 476 Compromise 47D Total Penalties (Sum of Hams 17A 0 176) 6 Total Amount Payablal(Overpayment)(Balanee to be cared overt the next tun Sam ettone 68 170) iB For Salo offooso Documentary Stamp tax by Revenue District Off 19 Total Amount of Documentary Stamps Sold for the Month (From Schedule 4 TS a TP Ha Tn a aT TD a GTO TTY ‘ost push potes a stofl sal Rvs Coe nea ne pasos od asa Saws AT np ended BS et Ue re marcas He pees mals corona uns Das vay At e2012 RAN OT roa aa lunes, Atos Raab ac shar or via Non-lsaidia: ‘ina over Pired Nae o Taxpayer orang Roprosoriatva Tax got ‘Sigare ovr Pod Nano of PresdonNice Prowaond (indesto Meibesgnaion ard 1) Auerine Offer of ReprosonatveTax Ago! fnseato Tie-Deeination and TI “Tax Agent Acerediation NoJ Date of issue Date of Expiry Attorney's Roll No. eaatesde) anwar _| Lomearren | Part Il Details of Payment Particulars [bawe Saageney [Number Date (awODYYYY) ‘Amount shank 0 TT wm ee nn pitt ri potpa spp ri yi ot at.chedy pi pitt oti botppsirpii yi bet zetexDevitMemo |) | yy phat ppp et 25 Otners feay) TI = rit bit rit riyisiity rit 1 tt Tact Vakdaton evr Of Roce Deak not fod wih an Autfaraod Agar Bank) ‘Stapf Receiving Ofi/RAB and Dao of Rovept RO’ SionaturatBark Toor rita) “NOTE: Pasa read te BIR Data Prvacy Poly found ithe BR wabale Gow bi-goH BATBIR Form Na 2000 January 2018 (ENCS) Page t Monthly Documentary Stamp Tax Declaration/Return WEE 2000 OT@ENCS P2 ie Taxpayers Name: ‘Schedule 1 Summary of Computation of Taxes Due forthe Month (ase adilond shoes T necoas ‘AIG Tax Base. “Tax Rato Tox Due ] piid L . L 1 L an piid L . L 1 L an pit L . L 1 L ay TOTAL TAX DUE (Totem 14) 1 A . ‘Schedule 2 Summary of Constructive Affisture for the Month (ue aaionl sheath Precssan) Payment Dates fawD0YYrY) | Revenue Offic Receipt No. (payment is made to RCO) Amount Paid ] vl A L L L 1 a f yo L L L L om ul ys L L L 1 om TOTAL PAYMENTIS (To fom 155) pari titiit ttl} ‘Schedule 3 - Summary of DST Paymonts/Purchases for the Month (se axonal heats Precossan) Payment Reference No, (pis tu oFPSTRievenve Payment Datels qaworvvvy) Ee eee eal ‘Amount Paid g yy L L L L a g yy L L L L a d He, L L L L a TOTAL PAYMENTIS (om 186) Ltt el ‘Schedule 4 Summary of Remittance from Collection on Sale of Loose Documenta “Stamps (ve wadtora shoei Foecossay] Roo Gade manmorrem) | Agent Bank | Amount Remitted From Ta nti Lom eee ele a on pers ses, iene scatter Be SST pay ae Paseo saree omen PaRa FaNTRTT a aris | a ees Tas ls ORT | Prove Posy oe SacI [oni [enetmetonne aaa ‘ess than one (3) year (08120 | Leases and Omar Heng Ayeements vexcaes P200/P 1,000 pew Geaenmmae [row [or [ronnemwctenatin |S pipsan Sot Sheree (be ae | snot ae [OS 770 Patties of Insurance upon Property Fos Pam be t3t | 1001 w 10,000 tre noxcess + P 200imort [ nexser = Paid