REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE

TAX REMITTANCE ADVICE

Serial No. : 0110752022676592

TIN : 000-005-097-000
Reference Number : 012200048495824

NAME OF AGENCY: POTOTAN NATIONAL COMPREHENSIVE AGENCY DEPT. FUND

RDO NO.: DATE:
HIGH SCHOOL CODE: CODE: CODE:
ADDRESS: BRGY. CAU-AYAN ILOILO DEPED DECS 075 101 06/30/2022
The Commissioner of Internal Revenue:
This is to remit the amount of One Hundred Twenty-Five Thousand One Hundred Two Pesos and 88/100 only (PhP 125,102.88) to cover
withholding tax liabilities for the month of : June/2022
Type of Tax:

1601 1601E 1601F

1600 1603
C Q Q
It is understood that the amount herein remitted shall be in accordance with the provisions of the National Internal Revenue Code of 1997,
as amended, and its implementing rules and regulations, and consistent with the prescribed budgeting, accounting and auditing rules and
regulations pursuant to the DOF-DBM-COA Joint Circular No. 1-2000, as amended by DOF-DBM-COA Joint Circular 1-2000A.

APPROVED BY: CERTIFIED BY:

___________________________________________________ ______________________
Head of Agency or Duly Authorized Representative Chief Accountant

BIR-RDO DATE: BTr-RO DATE: BIR-RO DATE:

(MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY)

Stamp of __________ Stamp of __________ Stamp of __________

Receiving Receiving Receiving
Office __________ Office __________ Office __________
Initial Initial Initial