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1601Cv2018 Page 1 of 1
1 For the Month (MM/YYYY) 2 Amended Return? 3 Any Taxes Withheld? 4 Number of Sheet/s Attached 5 ATC
07 - July 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)
HOLY CHILD KINDERGARTEN SCHOOL OF SAN ANTONIO ZAMBALES INC
9 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 Form No. 1905)
98 T.R. YANGCO, RIZAL, SAN ANTONIO, ZAMBALES
16 Holiday Pay, Overtime Pay, Night Shift Differential Pay, Hazard Pay (for MWEs only) 16 0.00
19 SSS, GSIS, PHIC, HDMF Mandatory Contributions & Union Dues (employee's share only) 19 0.00
23 Less: Taxable compensation not subject to withholding tax (for employees, other than MWEs, receiving P250,000 & below for the 23 0.00
year)
26 Add/(Less): Adjustment of Taxes Withheld from Previous Month/s (From Part IV-Schedule 1, Item 4) 26 0.00
28 Less: Tax Remitted in Return Previously Filed, if this is an amended return 28 0.00
33 Interest 33 0.00
34 Compromise 34 200.00
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)
Machine Validation/Revenue Official Receipt Details (If not filed with an Authorized Agent Bank) Stamp of Receiving Office/AAB and Date of Receipt (RO's Signature/Bank Teller's Initial)
*NOTE: Please read the BIR Data Privacy Policy found in the BIR website (www.bir.gov.ph)
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