Republika ng Pilipinas Certificate of Compensation BIR Form No.

Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas

For Compensation Payment With or Without Tax Withheld

Payment/Tax Withheld 2316
July 2008 (ENCS)
Fill in all applicable spaces. Mark all appropriate boxes with an "X"
1 For the year 1 2 For the period
(YYYY)
2021 From (MM/DD)
01 01 To (MM/DD)
12 30
Part I Employee Information Part IV-B Details of Compensation Income and Tax Withheld from Present Employer
3 Tax Payer 3 Amount
Identification No. 403 687 780 000 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME
4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code
Roldan, Regin, Pio 027
32 Basic Salary/ 32
6 Registered Address 6A Zip Code Statutory Minimum Wage
1405 0.00
71 Bayani Street, Caloocan City Minimum Wage Earner (MWE)
6B Local Home Address 6C Zip Code
33 Holiday Pay (MWE) 33
0.00
6D Foreign Address 6E Zip Code
34 Overtime Pay (MWE) 34
0.00
7 Date of Birth (MM/DD/YYYY) 8 Telephone number
09919723660
35 Night Shift Differential (MWE) 35
12 28 1988 0.00
9 Exemption Status
36 Hazard Pay (MWE) 36
X Single Married 0.00
9A Is the wife claiming the additional exemption for qualified dependent children? 37 13th Month Pay 37
Yes X No and Other Benefits 82,000.00
10 Name of Qualified Dependent Children 11 Date of Birth (MM/DD/YYYY) 38 De Minimis Benefits 38
Other Benefits 10,000.00
39 SSS, GSIS, PHIC & Pag-ibig 39
Contributions & Union dues 14,225.60
(Employee share only)

40 Salaries & Other forms of 40

Compensation 4,059.90
12 Statutory Minimum Wage rate per day 12
41 Total Non-Taxable/Exempt 41
Compensation Income 110,285.50
13 Statutory Minimum Wage rate per month 13

14 Minimum Wage Earner whose compensation is exempt from B. TAXABLE COMPENSATION INCOME
withholding tax and not subject to income tax
REGULAR
Part II Employer Information (Present)
15 Taxpayer 15 42 Basic Salary 42
Identification No. 223 724 698 000 192,782.40
16 Employer's Name 43 Representation 43
0.00
ALORICA TELESERVICES INC. 44 Transportation 44
17 Registered Address 17A Zip Code 0.00
45 Cost of Living Allowance 45
Bayshore Avenue, Seaside Boulevard Pasay City 1700 0.00
X main employer secondary employer 46 Fixed Housing Allowance 46
0.00
Part III Employer Information (Previous)-1

18 Taxpayer 18
Identification No. 47 Others (Specify)

19 Employer's Name 47A 47A

0.00
47B 47B
20 Registered Address 20A Zip Code
0.00

SUPPLEMENTARY
Part IV-A Summary
48 Commission 48
21 Gross Compensation Income from 21 0.00
Present Employer (Item 41 plus Item 55) 414,707.96
49 Profit Sharing 49
22 Less: Total Non-Taxable/ 22 110,285.50
Exempt (Item 41)
0.00
23 Taxable Compensation Income 23 50 Fees including Director's 50
from Present Employer (Item 55)
304,422.46 Fees 0.00
24 Add: Taxable Compensation 24 0.00
Income from Previous Employer 51 Taxable 13th Month Pay 51
and Other Benefits
78,564.00
25 Gross Taxable 25 304,422.46
Compensation Income 52 Hazard Pay 52
0.00
26 Less: Total Exemptions 26
100,000.00
53 Overtime Pay 53
5,679.28
27 Less: Premium Paid on Health 27
and/or Hospital Insurance (if applicable)
28 Net Taxable 28
54 Others (Specify)
Compensation Income 204,422.46
54A 54A
29 Tax Due 29
38,605.62 27,396.78
30 Amount of Taxes Withheld
30A Present Employer 30A
38,605.62 54B 54B
30B Previous Employer 30B

55 Total Taxable Compensation 55

31 Total Amount of Taxes Withheld 31 38,605.62 Income
As adjusted

the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
56 OSCAR MEDINA Date Signed 01 18 2022
Present Employer/Authorized Agent Signature Over Printed Name
CONFORME:
57 Roldan, Regin, Pio Date Signed
CTC No. Employee Signature Over Printed Name Amount Paid
of Employee Place of Issue Date of Issue

To be accomplished under substituted filing

I declare, under the penalties of perjury, that the information herein stated are reported under BIR
Form No. 1604CF which have been filed with the Bureau of Internal Revenue

58 OSCAR MEDINA
Present Employer/Authorized Agent Signature Over Printed Name
(Head of Accounting/Human Resource or Authorized Representative)

59 Roldan, Regin, Pio

Employee Signature Over Printed Name