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Annex D

Inventory List of Unused/Expired Principal and Supplementary Receipts & Invoices


As of (MM/DD/YYYY)

Name of Taxpayer:

Business/Trade Name:

Taxpayer Identification Number (TIN): Branch Code:

Business Address:

ATP OCN: Date Issued:

No. of Booklets No. of Serial Nos.


Sets No. of Copies
Per Per Set
DESCRIPTION TYPE Loose Bound Booklet From To

(Signature over Printed Name if Taxpayer)


Received By:

(TSS Chief/Registration Seition Chief)

Verified correct by:

(Officer of the Day - Assessment Section)

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