Professional Documents
Culture Documents
1 For the Month (MM/YYYY) 2 Amended Return? 3 Any Taxes Withheld? 4 Number of Sheet/s Attached 5 ATC
12 - December 2019 Yes
Yes No
No Yes
Yes No
No 0 WW010
8 Withholding Agent's Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)
I-TEMSI ACADEMY CORP
Registered Address (Indicate complete address. If branch, indicate the branch address. If the registered address is different from the current address, go to the RDO to update registered address by using BIR
9 Form No. 1905)
G/F 2264 RUBI ST., BRGY. 803 ZONE 87 DIST V, SAN ANDRES BUKID, MANIL
A 9A Zip Code 1017
Signature over Printed Name of Taxpayer/Authorized Representative/Tax Agent Signature over Printed Name of President/Vice President/
(Indicate Title/Designation and TIN) Authorized Officer or Representative/Tax Agent (Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney's Roll No. (If applicable) (MM/DD/YYYY) (MM/DD/YYYY)
PART III - DETAILS OF PAYMENT
Particulars Drawee Bank/Agency Number Date (MM/DD/YYYY) Amount
37 Cash/Bank Debit Memo
38 Check
39 Tax Debit Memo
40 Others (specify below)
*NOTE: Please read the BIR Data Privacy Policy found in the BIR website (www.bir.gov.ph)