REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE
Revenue District Office No. 75
Zarraga, Iloilo

A G R E E M E N T FO R M
The results of the verification of All Internal Revenue Tax liabilities of SEASHAPS MARKETING,
INC for the taxable year 2018 conducted by Revenue Officer Marian Claire C. Sangcada under Group
Supervisor Kristine Joy S. Alparaque pursuant to electronic Letter of Authority No. 075-2020-00000104
dated August 7, 2020 were satisfactorily explained to me.

Hereunder are the unpaid balances of the tax deficiency findings that
Domari L.T.Moreno
I, Raymond Gomez is amenable and agreeable as to its validity:

Internal Revenue Deficiency Taxes:

Income Tax P 14,785.85
Expanded Withholding Tax 1,201.91
Fines/Penalties 12,000.00
Unpaid Balance P 27,987.76

Payment of the above amount shall be made (check appropriate box)

(X) Full payment on or before December 31, 2020.

( ) Upon receipt of the corresponding Assessment Notice
( ) Upon issuance of the Payment Order in order to stop the running of interest incident to
delinquency

I understand that the report of verification submitted by the Revenue Officers is subject to review
and approval by higher authorities which may result in further changes in the amount of my tax liability
and will be recomputed if not paid on the date stated above.

Domari L. Moreno
_____________________________________
Signature over printed name of Taxpayer
or his/her authorized representative

ACKNOWLEDGEMENT
(Republic of the Philippines)
(____________________) S.S.

In the _________, on this ________ day of ______________, personally appeared before me

________________________________, with Community Tax Certificate No. ____________________
issued at ___________________________ on _________________, in his capacity as
__________________________ of _________________________________ known to me to be the
same person who executed the forgoing waiver and acknowledged to me that the same is his voluntary
act and deed, and that he is duly authorized to sign the same.

WITNESS MY HAND AND SEAL at the place and on the date first above written.

NOTARY PUBLIC

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