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15C 15D
15A 15B
15B 15E 0.00
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16C 16D
16A 16B
16B 16E 0.00
0.00 0.00
17C 17D
17A 17B
17B 17E 0.00
0.00 0.00
18C 18D
18A 18B
18B 18E 0.00
0.00 0.00
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TIN of Tax Agent (if applicable) Tax Agent Accreditation No.(if applicable)
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
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