Payment Form: Kawanihan NG Rentas Internas
Payment Form: Kawanihan NG Rentas Internas
Payment Form: Kawanihan NG Rentas Internas
Fill in all applicable spaces. Mark all appropriate boxes with an "X"
1 For the Calendar Fiscal 3 Quarter 4 Due Date ( MM / DD / YYYY) 5 No. of Sheets 6 ATC
2 Year Ended Attached
( MM / YYYY ) 1st 2nd 3rd 4th
7 Return Period ( MM / DD / YYYY ) 8 Tax Type Code BCS No./Item No. (To be filled up by the BIR)
I N
13 Taxpayer's 14 Telephone Number
Name
(Last Name, First Name, Middle Name for Individuals) / (Registered Name for Non-Individuals)
15 Registered 16 Zip Code
Address
19
19 Basic Tax / Deposit / Advance Payment
20 Add: Penalties Surcharge Interest Compromise
20A 20B 20C 20D
22A 22B
Signature over Printed Name of Taxpayer /Authorized Representative Title/Position of Signatory Signature over Printed Name of Head of Office
Part III D e t a i l s of P a y m e n t