Certificate of Final Tax Withheld at Source
Certificate of Final Tax Withheld at Source
Certificate of Final Tax Withheld at Source
6 Payee's Name (Last Name, First Name, Middle Name) For Individuals 7 Payor's Name (Last Name, First Name, Middle Name) For Individuals
Part II Details of Income Payment and Tax Withheld (Attach additional sheet if necessary)
Nature of Income Payment ATC Amount of Payment Tax Withheld
Total
We declare, under the penalties of perjury, that this certificate 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.
MUNICIPAL ACCOUNTANT
Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
CONFORME:
000-360-916-000
Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)
I declare, under the penalties of perjury, that the information 7 I declare under the penalties of perjury that I am qualified under substituted filing of Percentage
herein stated are reported under BIR Form No. 1600 which Tax/Value Added Tax Returns (BIR Form 2551M/2550M/Q), since I have only one payor from
have been filed with the Bureau of Internal Revenue. whom I earn my income; that, in accordance with RR 14-2003, I have availed of the Optional
Registration under the 3% Final Percentage Tax Wthholding/10% Final VAT Withholding in lieu
of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges accorded by the
Substituted Percentage Tax Return/Substituted VAT Return System prescribed in the aforesaid
Payor/Payor's Authorized Representative/Accredited Tax Agent Regulations; that, this Declaration is sufficient authority of the withholding agent to withhold 3%
Signature Over Printed Name Final Percentage Tax/10% Final VAT from my sale of goods and/or services.
TIN of Signatory Title/Position of Signatory Payee/Payee's Authorized Representative/Accredited Tax Agent Title/Position of Signatory
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Tax Agent Accreditation No./Attorney's Roll No. (if applicable) TIN of Signatory