Republic of the Philippines September 2023 Version

Department of Finance
BUREAU OF INTERNAL REVENUE ANNEX “J.8”
Quezon City
QF-TCC-07-04-2023.00

APPLICATION FOR DELINQUENCY VERIFICATION REPORT

(To be accomplished by the Authorized Officer of Non-Individual Taxpayer [Corporation/Company]
Securing Delinquency Verification Report for Tax Clearance for General Purposes)

I, ____________________________________________, Filipino/____________(indicate nationality

for non-Filipino citizenship), of legal age, single/married to_____________________________________,
permanently residing at _____________________________________________________________ with
Taxpayer Identification Number (TIN) __________________________________, after having been duly
sworn in accordance with law hereby depose and state:

1. That, ____________________________________________________________________________
(name of the non-individual taxpayer-applicant)
with Taxpayer Identification Number (TIN) __________________________________ is a
corporation/company duly organized and existing under and by virtue of the Laws of the Philippines,
with Office located at ___________________________________________________________nature/
line of business_________________________ and engaged in the business
as__________________________;
2. The firm name, business trade or style has been duly registered in the Securities and Exchange
Commission on ___________________ under registry No. ______________________________;
3. That it is registered with BIR under Certificate of Registration No.
__________________________issued at RDO/LTDO No._________________ on
_________________;

4. That, the following documentary requirements in relation to the aforesaid application are all authentic
and hereto attached in compliance with the existing policies.

_____ a. One (1) piece of loose documentary stamp tax worth P30.00;
_____ b. For Corporation - One (1) original copy of Secretary’s Certificate OR One (1) original
copy
of Board Resolution, with attached One (1) photocopy of latest General Information Sheet
(GIS) duly received by the Securities and Exchange Commission (SEC);
For One Person Corporation (OPC) - One (1) photocopy of latest General Information
Sheet (GIS) duly received by the Securities and Exchange Commission (SEC) and One (1)
original copy of valid and properly accomplished Special Power of Attorney (SPA) signed
by the applicant, applicable only to applications through an authorized representative;
For Partnership - One (1) original copy of Partnership’s Certificate OR Partnership’s
Resolution; and
_____ c. One (1) photocopy of each valid identification cards (any government issued ID) with three
(3) specimen signatures of the applicant and the authorized representative.

5. And that, to the best of my knowledge and belief, I have satisfied the prescribed criteria for the issuance
of Delinquency Verification Report specifically for ______________________________.

______
______________________________________
Signature over Printed Name of Authorized Officer