1702 Q
1702 Q
1702 Q
DLN: PSIC:
18 L Income
Add: Other Non-Operating and Taxable 18A 18B
28D Add: Tax Due to the BIR on transactions under Special Rate (25A less 26)…… …………….
28D
30B Tax Payment(s) for the Previous Quarter(s) of the same taxable year other than MCIT 30B
30C MCIT Payment(s) for the Previous Quarter(s) of the same taxable year 30C
30E Creditable Tax Withheld Per BIR Form No. 2307 for this Quarter 30E
30F Tax paid in Return Previously Filed, if this is an Amended Return 30F
We declare, under the penalties of perjury that this return has been made in good faith, verified by us, and to the best of our knowledge and belief,
is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
34A 34B
President/Vice President/Principal Officer/Accredited Tax Agent/ Treasurer/Assistant Treasurer
(Signature over printed Name) (Signature over printed Name)
Tax Agent Acc. No./Atty's Roll No. (if applicable) Date of Issuance Date of Expiry TIN of Signatory
Part III D e t a i l s of P a y m e n t Stamp of Receiving
Drawee Bank/ Date Office/AAB and
Particulars Agency Number MM DD YYYY Amount Date of Receipt
35 Cash/Bank 35A 35B 35C 35D (RO's Signature/
Debit Memo Bank Teller's Initial)
36 Check 36A 36B 36C 36D