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Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Payment Form
September 2003(ENCS)
1 For the Calendar Fiscal 3 Quarter 4 Due Date (MM/DD/YYYY) 5 No. of Sheets Attached 6 ATC
2 Year Ended (MM/YYYY) 1st 2nd 3rd 4th 01 31 2022 0 MC180
12 - December 12 -
December 12 -
December 12 -
December 2022
Tax
7 Return Period (MM / DD / YYYY) 12 31 2022 8 Type
RF
Part I Background Information
9 Taxpayer Identification No. 10 RDO Code 11 Taxpayer Classification 12 Line of Business/Occupation
175 119 760 001 54A 54A 54A 54A I N MANAGEMENT/ADMINISTRATIVE SERVICES
13 Taxpayer's Name (Last Name, First Name, Middle Name for Individuals) /(Registered Name for Non-Individuals) 14 Telephone Number
TAN, MELVIN DAVA (046)4166581
15 Registered Address 16 Zip Code
UNIT 13 3F ANNEX GB CALDO BLDG SALAWAG DASMARIÑAS CITY CAVITE 4114
17 Manner of Payment 18 Type of Payment
Voluntary Payment Per Audit/Delinquent Account Installment
Self-Assessment Preliminary/Final Assess/Deficiency Tax No. of Installment
Penalties Accounts Receivable/Delinquent Account Partial Payment
Tax Deposit/Advance Payment Full Payment
Income Tax Second Installment(Individual)
Others(Specify)
REGISTRATION FEE
Part II Computation of Tax
19 Basic Tax/Deposit/Advance Payment 19 500.00
20 Add: Penalties
Surcharge Interest Compromise
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
file:///C:/Users/User/AppData/Local/Temp/%7BC2BD166B-6F35-4A7D-867E-BF04... 01/12/2022