Republic of the Philippines Forel“ acs) Department of Finance Use Only item: ‘Bureau of Internal Revenue a For No 1701 Annual Income Tax Return TH Fi Individuals (including MIXED Income Eamer), Estates and Trusts 4 amiaryzmna ens) | exral gtted meter PPA LETTERS ture LACE eek pe beth 1 Be, canoe ma bee wate Bante et ge ere eae Paget eS PA 1 Forthe Year (ry [2 0 2 Amended Return? ‘Yes [X] No | 3ShortPeriod Retun? L] Yes No ee c PART [- Background Information of Tax 4 Taxpayer identification Number rm) | 7, 4 3] - | 1) 8) Of -[1)5)7]-|0,0)0)0)0] S RDOGede [7A STaxoayerType LX) Single Proprietor [| Professional [-] estate [J Trust] compensaton earner 7 Alphanumese Tax Cade (ATC) [X{]I012 Basse leone Grated Rae [_] Te heane ton Froth Gees [ —] 1019 Med ooonm Ge dbn Race Liott conpensaton income [_]inisBinteeronne-enr fee [] WitnoretenPrioien-euit ran] its Med mene ee 1 Taspayer’s Nato (at Naa Ft ham, Mera VESTATE OF (Lae, Mit Ne Las Haney’ TRUST FAO: Fao, is Wr asa GUTIERREZ, | GLARISSB, | THENGAN, yy yy ips iii iy 3 egiTred AGS (ado spl on Feira nds Tv on ce se bi RED Lagat aga Pes BREY, \BADAYANG VECTORDA, TARDAG | 1 vip yyy pai ig bitiiy Debi pip peer ee pi gi 1 yy | 8AzP Code [2,3 2 8 0 Dats of AR AmB | Tt Ema Adress 14212 812000] i fiz Ctzenship 5 Cling Frc Tax Gaia? 14 Foreign Tax Numer, amnabo FUMIE TNO, yy yyy Chye vel] | py ypuiiiriiiiis Fs Gori Number Cnanaalshone na) —| 76 Cl Statue api Tifiispa.apa TX singe ClManiea [tepaly Separaed _[-] Widower 7 fared, spouse has income? Yes Wo [ta Fiing Satis [] Joint ring _[_] Separate Fling 9 Incame EXEMPT from income Tax? — [] Yes TX] No | Ao Hose lbp ts GECIMUPREFERENTIAL RATE? Eo] Yes Pa Neo rps fet ln eon of ALL sciee pr Ta Rage Pat} >| ~ pryen blouse cossidao of LL eer pr Ta adne Pwr _| far rax "FIR Method of Deduction hose or) Rate" [X] Graduated Rates itemized Deduction [E] Optional standard Deduction fospy cosee ere) owe oted er eaten som oa) DC eersgaen he one surat x. MRC) [0% in eu of Gracuated Rates under Seo. 24(A) & Percentage Tax under Sec. 116 of NIRO oamte gos sleet nen zest oot ee Ives io pee a) PART I= Total Tax Payable ONT oer Geta Scrmuian feoe Bae Pariulars ‘A TaxpayerFiier B. Spouse [22 Tax Due (From Pat Vitam 5 bo 13181616290] pp pin [23 Less: Total Tax Crecits/Paymenis (From Par Vitam 10 1764 [24 Tax Payablel(Overpayment) (tm 2ece hom 5) hi yy seerel ¢ 7 Gi i 1 [25 Loss Porion of Tak Payette Alowad for 2 inclmart tb pad on a blereCeeber TS (omer iezot em Ditbiprritripririt 6 Arrount of Tax Payable/(Overpayment) ito 24 Lees fom 25) rt ys 86a pp tad 1 ‘Adé: Penalties 27 intorest Piet Ligilfiiaz iii Gaal 1 wu iain 1 Fas RiactioBbertanad za Comerories Peat ep Ae heel thet Hel 30 Total Penalties (Sum of tems 271023) aa piggy tego] poe py ye 1 Total Amount Payable/(Overpayment) Sum oftans 2 and 30) pi ylydySiSBi6l pap ta yt 12 Aggregate Amount Payable/{Overpayment) (Sun oftems 914 and 910) 1 gh 2 5498/6 Toverpayrnen, aK ore [7)bot ony. (Gnoe te ahora made, th same is MEVEGRER] [Jrobe minded [Tobe sued 2 Taxcrect Cottfewie(TCC) |_| To becarled over a a tax oredt for nt yeaguacar alas under Ws pal of py Wl srr, ad I wart, ive Doan do good Bi, vad BY ms, arse Dest fay owed an ele, rete and com, pusua th pros ote Nan el Reveme Cd 36 ended, a te ecto sed under eer are Furth, |g ny cnet te proceso ny tsar aren nr "Daa Pscy et 2012 oo) ana eh ya tn Ror es ta aha a AREF TL RRA: |33 Number of Attachments | ied Name ar sige fy ampaye Autor Resonate PART II Details of Payment Pariculars | Draws Banigensy ‘Number Date MDBIYH) —]— Amount x a oaswboc deters | Pp PP LoS 36 Check vere t Dee ee eee Ta Ty OEPTH Tax Piers Last Name 7)4/3,2,810,2,57,0,0,0,0,0[G,0, TIE, RRB 2 1 ————— PART W = Basen omar of Soca 1 Spouse's Taxpayer Identiteation Number 1) [=] 1 1 [=] 1 1 [-[0;0;0;0,0] zRDOcde | | | 3" Flers Spouse Type Sinale Proprietor LI Prtessional ‘Gomipensaton Eamer J4Alphanumetic Tax Code (ATO) [__]l0128uxhooe eine Giadited Fates [_] 101sIone fom rotecer Grasse Rees [__] 10'S bel rene Graded Falco [ttt congersaton income [iotseusbmstesoee-extr fae (| torTonatonPetaion-esiT fa [| 1'ekind ane eT Rao E Spousels Nar (ax Nano, ono, Mi Nara a point chge Poo 8 Claiming Foreign Taxcredtse [] ves C] no [SFowmigntexNumber Ts yy Fi inorse EXEMPT Fom income Tax? -] Yee [No] 17 Fase sibact to SPEUALPREFERENTIAL PATE? [1 Yes =] No [yon owns consandnon f LL eas pe Ta Regine a7) [ym ost aie censlanton of AL in pr Ya Rie ParTE Fz Tex "2A Method of DERN (aoc om) ator [] Graduate Retos {L_] temzod Quduston”[~] Opfonl standard Deduction (080) (none on) — (Orne odor Dotetonn ton on) Ronson nae Se SuuroopinsuesPoc Sc, 44, NRC) [1 8% in fou of Graduated Rates undor Soo. 24(A) & Perventage Tax under Ses. 116 of NIRC [alae Fase saeshocee and eer non perigee 2a re aka Tews mn esos (20 PART V— Computation of Tax [Schedule 1 ~ Gross Componsation Income and Tax WIheId (tach Adeiionel Shoo, fnecesta ‘Gnifone 7 ard 2, rl the oqurodintormao fr each of your employe and rk wher the kamatan rhe Twxpayar arte Spouse On eam @h erirthe Total Gross ad Tea Tx Waal fr the Taxpayer anon fn 2, tt NOT at Cart 40 Corts Lae. Sermon rund ‘Nae of Employer qPAtapaver| op Spouse | | ier TN potiritrrriit 2 Pytmeaer| pp colin betiprirrrirs | Spouse | yp py | bemyeroTtN || yy Contiaton of Table Above) ame = Compeatalon ane a Tawiined a povriviitiripiiiii Z ‘ pirviirviiftiririiiit ‘Sioss Compensation income ard Total Tax Wither SA TRPAVER Go Pu see om Pat Ve 8) Pipitpirtirriririt 35 te Corporation eri nd al Tex WTS rigrris ts i STOLE cara Scat 8 trata Sefiedile ~ Taxable Compensation Income [eT ET TOT ETT Parbtlare T 7, Taxpayer B, Spovse 4 Gross Compensation Income (Fm Pav Ssh # Re 24/85) (Cpr pete | part Bless: Non-Taxable / Exernp! Compensation ° [ep re [ey Pe 6 Taxable Compensation Income (tem # Loss tm 8) pratt sistoitnyaiyt 7 Tax Due-Compensation Income (len 6xepncabie name Tax Rate) rrpsirar is tay L Schedule 3 ~ Taxable Business Insome graduated rates, flin lems 0 to 24, 169% fat income tax rate fila Roma 250 0) SA= For Graduated income Tax Rates 8 Sales/Revenues/Receipts/Fees To 4850] pee 9 Less: Sales Retums, Alowances and Discounts Peo a [10 Net Sales/Rovenvos/RoceiptalFoes (tem 6 ase Fem 9 14123815100) ppp riiit Hf Less: Gost of Seles/Servces (qppicabie ol irevating Ronee’ Owais) 1,4)4/ 814,715 LL [12 Gross Income/(Loss) from Operation (tom 10 Less kam 11) [oy 12961 9,0;0)2)5] ppp ruait Tess: Dedugions Alovable under Gxsing Lave. 13 Orcnay Allowable Hemized Deductions om Par VSeheaie diem @ | y 2401314161215] 1) 411114 18 Special Alowabie Nerized Deductions (romPeaVcealeSiendadorler@| yy 4 1 1 111 | 14444414 15 Alans Nt Opis Lae Gny Or NOLGD] Fem FatVSmaieOhenatirea | yy yyy | 14414411 6 Toll Alowable emized Deduclons (Sum of tame 19015) Cosel pou a4 i OF 177 Optional Standard Deduetion (08D) bore 1) pia titi t iti 1 Net inorme/.0) et en 1 ss en 6 OB fe enh 112655400] ppp pia "a Oter Non: Soecing Ins [ape Baow] 19. pi poi a oo on Ed — pi4 1 1 1 Bad tt) [21 Aount RecevedShare ninco by a Paster rom Gan [22"Total Other Non-Operating Income (Sum of tems 19402) [23 Taxable Income-Business (Sun offers 16 and 22) BA Rw atTN - Tax Filer's Last Name = 7,4 3,1)8,0,1,5 7,0, 0,0,0,0/G, UTI ERR E Tata SLn rooms aR [ST EET SoS - ayer capa 8 GlenrRavaruerRecipaF oes coast ams aan) | i tir Ne Opt ne sb : ar _ l Tian iti d@ L [28 Less: Albarn einsion Fon gram ose and cis var cpuntng icone of pray woe OF ene vc et brs bp ar PAO sea rae _ [30 Taxable Inceme/(Loss) (tem 28 Less tam 29) [st Tex Due Busines comer 30488 Fal TF [2 Teta ex OoeComperaton Bus eae user artnet omeewnm) |) Shedulo 4 Ordinary Alowable Remzed Deductions (ach od@iona sieeve Wesoseay) 1 Amortizations| 2 Bad Debis 3 Ohartable and Other Contributions 4 Depieton i 5 Depreciation i 6 Enterfainment, Amusement end Recreation 7 Fringe Benefits B interest PLEELEL 9 Losses fa Pension Tras Fi Reval [tz Reearthand baled 1 Salas, Wages and Alowances F488, GSI, Piel, HOMF and Ger Cailbufons a 6 Taras and Leases Ted }16 Transportation and Travel Litt itistiaitiait 7 Others (Deductions Subject to Witholng Tax and Other Expenses) [Sealy Sew, Ad elton Foe, recess ‘a |vanitorial and Messengerial Services . pinpireritirariipit b [Professional Fees Lt ¢ | Securty senices 1 £ oo on a os a a ae ee 8 et Sy Aid nda (tPA 034,625] sy pai [Schedule 5 Spoctal Alowable lem [zed Deductions (afach sodlional sheet, Precessayy) A= Taxpayer Fler Dasorision Tega bass, ama pepe pie pret iriiiys boprtit Lititiiiiiririiriiit boprirritizviriirit 3 Total Special Alowabe Remized Deductons-TaxpayorFlr (Sun of ams 4 and 2) (To Pat V Schedule 2.4 tem 14) Z TB=Spouse a Cee porriirietorripir ris Ee porerrrirtirririin 6 Total Special Alowable itemized Deductions-Spouse (Sum of ems # and 6) (To Part v Sotiedute 2. em 148) ‘ edule 6- Computation of Net Operating Loss Cary Over (NOLOO] ‘BA Computalion of NOLCO. Desaription ‘A Taxpayed Fer —— Spouse rons Ire bipiterirtiipiiris 2 Less: Ordinary Alowable Homized Deductions ifittrirbpie ea ‘Net Operating Loss its ten 9 (oScietie AAT tan TAdrSohewbA? ent20] yy | 1 4 1 4 Lert 4 ‘A= Toxpayeler Detaled Computation of Available NOLO Net Sperling Loss B, NOLCO Apyiled Year inoured ‘A Arount reuicus Ye eat et E Ret operang Loss Peles) arto) D.NOLCO Apziled Curent Yearcw | Tax Fier's Last Name : o (Cantnvation of Sched 6) SB pee Sead np IOT RTE TOTES Te peg No.0 Aor a NoLoonmiee | ENA DpraITOR Veermaned [A Amoi rovousvane | &NOLoO Bind Screen eee a — —— Fo hs He | Yl NOLO Sp i e561 Pa Sai a a FART i= Sonmany of ne TD Regular Rae reae Tax Due (ana era 25552) 1386620]. Specie Rateincore Tax Due (From Pt em TTA) oe de Les: Share of ter Goverment Ageoy, onto dhedviobefomey [yyy 44a |. 4 1 14 14 4 Net Special Rate~neare Tx OulShere of Nafonal Govt. fous fa) ee 5 Totl income Tax Due (Sum ef tome 14-4 (Toa to 22) 1 386 ,6,2,0 PART Wi Tax Gre Payments (at30h poo F rior Years Excess Grits Li [2 Tax Payments for the First Three (@) Quarters 1 21716314), 4 3 Crediable Tax Withheld forthe First Three (@) Quarers [4 Greditable Tax Withheld per BIR Form No. 2807 forthe 4% Quarter 5 Crea Tx itd por AR Fea 2516 (om Pt V Ssh 1m RED 6 Tax Paid in Retum Proviouly Fle, tise an Amended Retum [7 Foreign Tax Credits, Feppicable : |B Special Tax Cred, tapnisate (To Pat il Fem) 9 Other Tax Gredis Payments (rec) 0 Total Tax Credte/Payments (Sum of ers {fo9) (To Petia 29) 27,063.41, 1 TART Vila Rate einen! Vira = Special Rate Regia nor Tax Onde Oue Pat Xan 128 Wa 6° Xe et here xa) tans a1 Re 78 arian 2 Tax Releton Spel Alowobe Nonizad Deduoions lion 7 nen 7 3 SubTotal — Tax Relief Sum of tems 1 and 2) — 4 Less: income Tax Due (From Part x item 178 end Kom #76) ‘5 Tax Relief Avaliment Before Special Tax Credit (fem 8 Lass liam 4) (6 Adc: Special Tax Credit, any (From Part Vil fam 8) TES ecenat Reger Tex Of De atin (te Nap gi Fovivas) | ; ree Teen 2 9 TaxRae on Spud Nowe Merl Dosctine OAH apelin EX | 0 Total Tax Reef Avalreric EXEMPT (Sumatran Ban 9) oy PART IX Reconcllaton of Netincome por Books Again Taxable Income (tech sdatona sh Particulars ‘A, TaxpayerFller ‘4 Net incemer{Loss) per Books 5 1265 ,5,4,0,0 [Add Non-Dodivible Exponsee/Taxabis Other Mears Z pode rrrifira iii 3 poviperri tira ir irin 4 L L ‘STotal Sunoftons 1104) Less Aj NoncTavabre nears ara [neome Subjected 0 Final Ta & a Lott tt 7. ee ee ppg 7] Scam Roan DABS ~ te itt 4 Ya a a Se a 2 on on oF 1 to wo 1 10 Teal (um aens 616) Peo fa TH Net Taxable Incomel{Loss) (ton Sins 1) 16515400111, pia STRBLE = a Rag [oecTne Tnuy te To DcebarT STABLE 7 Tx Rats erect Jeruary 20 and oar TTeuabieincomels Tax Duels emer TaxCCLARISSE | GUTIERREZ Brey Balayang, Victoria, Tarlac HEPTAGON NON-SPECIALIZED WHOLESALE TRADING STATEMENT OF INCOME & EXPENSES Forthe year ended December 31, 2021 Sales Tess: Cost of Sales Inventory Beginning. 4,438,500.00 4,519,735.63 ‘Add: Purchases g 2,278,853.44 Total 3,798,089.07 Less: Inventory End 2,349,614.07 Cost of Sales 1,448,475.00, Gross income 2,690,025.00 Less: Operating Expenses Communication, Light and Water 135,916.00 Fue! & Oil 284,231.22 Depreciation Expenses ’ 52,623.64 Miscellaneous Expenses 41,385.00 Repairs & Maintenance 79,361.00 ‘Taxes & Licenses 441,108.23 ‘Total Operating Expenses 1,034,625.00 [Net income Before Tax ‘ 3,655,400.00 Less: Provision for income Tax 386,520.00 NNETINCOME FOR THE YEAR 2,268,780.00CLARISSE | GUTIERREZ Brey Balayang, Vietoria, Terlec HEPTAGON NON-SPECIALIZED WHOLESALE TRADING ‘STATEMENT OF FINANCIAL POSITION Forthe year ended December 31, 2023 ASSETS Current Assets: ‘Cash & Cash Equivalents ‘384,020.00 Accounts Receivable ‘860,540.00 Merchandise Inventory 2,349,514.07 Total Current Assets 4,394,174.07 Fined Assets: Service Vehicles 3,120,000.00 Residential House & Lot 2,500,000.00 Furniture & Fixtures - 2,525,000.00 ‘Store Improvements 2,504,021.00 Total 10,649,024.00 Less: Accumulated Depreciation 7,811,324.07 Total Fixed Assets 2,737, 696.93 Other Assets Total Assets 6,931,871.00 LIABILITIES & NETWORTH ABILITIES Accounts Payable $050,246.00 ‘Acerued Expenses 700,164.00 ‘Total Liabilities 750,410.00 Networth Capital Beginning 3,912,581.00 ‘Add: Net Income 1,268 780.00 Total Networth “5 181,461.00 Total Liabilities & Networth 6,933,871.00CCLARISSE | GUTIERREZ Brey Balayang, Victoria, Tarlac HEPTAGON NON-SPECIALIZED WHOLESALE TRADING STATEMENT OF CASH FLOW Forthe year ended December 31, 2021 Net Income 1,268,780.00 Depreciation Expense 52,623.64 Payment to Suppliers (297,903.64) Collection of Receivables ‘560,520.00 Net flow From Operations 0CESAR F. MATEO. CPA . ‘ACCOUNTING OFFICE a Lot 19, Bik. 27, Habitat Resettlement, Bagong Bano ‘Sapang Maragul, Tarlac City Tel. No. (045) 982.0448, REPORT OF INDEPENDENT PUBLIC ACCOUNTANT T have audited the accompanying interim financial statements of HEPTAGON NON-SPECIALIZED WHOLESALE TRADING, whieh compromise the statements of financial position as of December 31, 2021, and the statements of income and expenses and cash flows forthe year then ended. ‘The management is responsible for the preparation and fair presentation of these financial statements in accordance with Philippine Financial Reporting Standards (PFRS) for small and medium-sized Entities (SMBs) issued by Philippine Financial Réporting Standards Council; and for such intemal control as ‘management determine is necessary to enable the preparation of financial statements that are free from ‘material misstatement, Whether due to fraud or emer. ‘My responsibility i to express an opinion on these financial statements based on my audit, I enducted my audit in accordance with Philippine Standards on Auditing. Thoso standards require that I comply with cthicel requirements and plan and perform the aygit to obtain reasonable assurance whether the financial statements are free from materia! misstatement, ‘An audit involves performing procedures to obtain audit evidence about the amounts md disclosure in the financial statements, The procedures selected depend on the euditor's judgment, including the assessment of th risk material misstatement ofthe financial statements, whether due to fraud or eror. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair preseatation of the financial statements in order to design audit procedures thet are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness on the entity's intemal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by mmagement as well as evaluating the overall presentation. of financial statements, I believe thet the audit evidence T have obtained is sufficient and appropriate to provide a basis for my opinion. Jn ayy opinion, the financial statements present fairy, in all materials respects, the financial position of HEPTAGON NON-SPECIALIZED WHOLESALE TRADING as of December31, 2021 and the results ofits operation forthe year then endedin accordance with Philippine Financial Reporting Standards (PERS) for small and medium-sized Entities (SMEs). (My audit was conducted for the purpose of forming an opinion on the basis financial statements taken as a ‘wile, The supplementary information on taxes and licenses diselosed as “Recent Regulatory Compliance - BIR” in the notes of financial statements is presented for the purpose of filling with the Bureau of Internal ‘Revenue and is not required pact of the basis financial statements. Such information has been subjected to the auditing procedures applied in my audit ofthe basic financial statements and my opinion, i finy stated in all material aspects in elation tothe basic financial statements taken as a whole, PIR No, 35503628 Jenny 05,2023 “Teae CaySTATEMENT OF MANAGEMENT'S RESPONSIBILITY FOR ANNUAL INCOME TAX RETURN ‘The Management cf HEPTAGON NON-SPECIALIZED WHOLESALE TRADING, is responsible for all information and representation contained in the Annual Income Tax Retum for the year ended ‘December 31, 2021. Management likewise responsible for all information and representation contained in the financial statements accompanying the (Anqual Income Tax Return of Annual Information ‘Retum) covering the same reporting period. Furthermore, the Management is responsible for all the information and representations contained in all the other tax returns field for the reporting period, including, but not limited, o the value added tax and/or percentage tax returns, withholding tex returns, documentary stamp tax returns and all other tax returns. a) The Annual Income Tax retum has been prepared in accordance with the provisions of the ‘Natioual Infernal Revenue Code, as amended, and pertinent tax regulations and other Issuances of the Depastment of Finence and the Bureau of Internal Revenue; 8) Any disparity of figures in the submitted reports arising from: the preparation of financial statements pursuant to financial accounting standards and the preparation of the income tax returns pursuant to tax accounting rules has been reported as reconciling items and maintained in the company’s books and records fn accordance with the requirements of the Revenue Regulations No, 8-2007 and other relevant issuances; ©) That HEPTAGON NON-SPECIALIZED WHOLESALE TRADING fled all applicable tax setums, reports and statements required to be filed under Philippine tax laws forthe reporting period, and all axes and other impostions shown theraoa tobe due and payable aave been paid fr the reporting period, except those contested in good faith asingee NE