DATE ________________________

TO Human Resource Department

GLACIER BALAGTAS REFRIGERATION SERVICES CORP.
Road 1 Street, Interglobal Industrial Complex
Brgy. Camachilihan, Bustos, Bulacan

CERTIFICATION

This is to certify that I, Mr. / Ms. ______________________________________ of legal age,

Name
____________ with postal address at _____________________________________________________
Civil Status
and presently working at Glacier Balagtas Refrigeration Services Corporation as
____________________________________ with TIN __________________ certify that I was not able to
submit the required Certificate of Income Tax on Compensation (BIR Form No. 2316) from my
previous employer due to:

Please check reason:

_____ No previous employer
_____ Certificate of Income Tax Withheld on Compensation (BIR Form No. 2316) is not yet
available from my previous employer

I further certify that whatever taxes due from me as a result of my failure to submit the above
documents to Glacier Balagtas Refrigeration Services Corporation will be borne by me and I will pay
directly to the Bureau of Internal Revenue (BIR) upon filing of my Income Tax Return (ITR) for the
year 2020.

_______________________________
Signed

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

____________ )ss

Before me, a notary public for and in above locality personally appeared the following persons to wit,
known to me and known to me the same person who executed the foregoing and that they
acknowledge to me the same is their free act, will and deed.

WITNESS MY HAND AND AFFIX MY SEAL

Doc. No. ______

Page No. ______
Book No. ______
Series of 20____