(To be filled up by BIR) DLN: __________________________

BIR Form No.

Republic of the Philippines Application for Registration
Department of Finance
Bureau of Internal Revenue 1901
January 2018(ENCS)
For Self-Employed (Single Proprietor/Professional),
Mixed Income Individuals, Non-Resident Alien - - -
Engaged in Trade/Business, Estate and Trust TIN to be issued, if applicable (To be filled in by BIR)
Fill in all applicable white spaces. Mark all appropriate boxes with an “X”.
Part I – Taxpayer Information
1 PhilSys Number (PSN) 2 Registering Office 3 BIR Registration Date
(To be filled up by BIR)(MM/DD/YYYY)

Head Office Branch Office

4 Taxpayer Identification Number (TIN)
(For Taxpayer with existing TIN) 123 - 456 - 789 - 0 0 0 0 0 5 RDO Code
(To be filled up by BIR
6 Taxpayer Type
Single Proprietorship Only (Resident Citizen) Mixed Income Earner – Compensation Income Earner & Professional

Mixed Income Earner – Compensation Income Earner, Single

Resident Alien – Single Proprietorship
Proprietorship & Professional
Resident Alien – Professional Non – Resident Alien Engaged in Trade/Business

Professional – Licensed (PRC, IBP) Estate – Filipino Citizen

Professional – In General Estate – Foreign National

Professional and Single Proprietor Trust – Filipino Citizen

Mixed Income Earner – Compensation Income Earner & Trust – Foreign National
Single Proprietor
7 Taxpayer’s Name (If Individual) (Last Name) (First Name) (Middle Name) (Suffix) (Nickname)

MENDOZA FAYE DIANNE DOMINGO D FAYE

(If ESTATE, ESTATE of First Name, Middle Name, Last Name, Suffix) (If TRUST, FAO: First Name, Middle Name, Last Name, Suffix)

8 Gender Male Female 9 Civil Status Single Married Widow/er Legally Separated

10 Date of Birth/Organization Date (In case of Estate/Trust) (MM/DD/YYYY)) 04 01 1998 11 Place of Birth MANILA
12 Mother’s Maiden Name MEL BRIGINO 13 Father’s Name JIM MENDOZA
14 Citizenship FILIPINO 15 Other Citizenship
16 Local Residence Address
Unit/Room/Floor/Building# Building Name/Tower Lot/Block/Phase/House No. Street Name Subdivision/Village/Zone

327
Barangay Town/District Municipality/City Province ZIP Code

BUNSURAN 1ST PANDI BULACAN 3014

17 Business Address
Unit/Room/Floor/Building# Building Name/Tower Lot/Block/Phase/House No. Street Name Subdivision/Village/Zone
327
Barangay Town/District Municipality/City Province ZIP Code

BUNSURAN 1ST PANDI BULACAN 3014

18 Foreign Address
19 Municipality Code 20 Purpose of TIN Application
(To be filled up by BIR)
21 Identification Details (e.g. passport, government issued ID, company ID, etc.)
Type ID Number Effective Date (MM/DD/YYYY) Expiry Date (MM/DD/YYYY) Issuer Place/Country of Issue
PASSPORT AB12345 04 01 2020 04 01 2021 DFA PHILIPPINES
22 Preferred Contact Type
Landline Number Fax Number Mobile Number Email Address (required)
123-4567 [email protected]
23 Are you availing of the 8% income tax rate option in lieu of Graduated Rates? Yes No
PART II - Spouse Information
24 Employment Status of Spouse Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession

25 Spouse Name (Last Name) C(First Name) C (Middle Name)C (Suffix) 26 CSpouse TIN
i i i i
v v v v - - - 00000
i i i i
27 Spouse Employer’s Name (Last Name, First
l
Name, Middle Name, if Individual)(Registered Name, if Non-Individual)
l l
28 lSpouse Employer’s TIN
- - - 00000
PART III – Authorized Representative
29 Relationship Name (For Authorized Representative)
If Individual (Last Name) (First Name) (Middle Name) Suffix

If Non-Individual (Registered Name)

 Page 2 – BIR Form No. 1901

30 Relationship Start Date (MM/DD/YYYY) 31 Address Types Residence Place of Business Employer Address

32 Local Residence Address

Unit/Room/Floor/Building# Building Name/Tower Lot/Block/Phase/House No. Street Name Subdivision/Village/Zone

Barangay Town/District Municipality/City Province ZIP Code

33 Preferred Contact Type

Landline Number Fax Number Mobile Number Email Address (required)

Part IV – Business Information

34 Single Business Number
35 Primary/Secondary Industries (Attach additional sheet/s, if necessary)
Industry Trade/Business Name Regulatory Body
Primary MENDOZA ACCOUNTING OFFICE
Secondary
Business Registration Date PSIC Code
Industry Business Registration Number (MM/DD/YYYY) (To be filled up by BIR)
Line of Business

Primary 1234567 02 15 2021 ACCOUNTING SERVICES

Secondary
36 Incentives Details
36A Investment Promotion 36B Legal Basis 36C Incentive Granted
(e.g. PEZA, BOI) (e.g. RA, EO) (e.g. Exempt from IT,VAT,etc.)

36E Incentive Start Date 36F Incentive End Date

36D No. of Years
(MM/DD/YYYY) (MM/DD/YYYY)
37 Details of Registration / Accreditation FROM TO
37A Registration / Accreditation Number 37B Effectivity Date (MM/DD/YYYY) (MM/DD/YYYY) 37C Date Issued (MM/DD/YYYY)

37E Tax Regime (Regular, Special, 37F Activity Start Date 37G Activity End Date
37D Registered Activity Exempt) (MM/DD/YYYY) (MM/DD/YYYY)

38 Facility Details (PP-Place of Production/Plant; SP-Storage Place; WH-Warehouse; SR-Showroom; GG-Garage; BT-Bus Terminal; RP-Real Property for Lease with No Sales Activity)
38A Facility Code 38B Facility Type PP SP WH SR GG BT RP Other (specify)
(To be filled up by BIR) F
38C Facility Address
Unit/Room/Floor/Building# Building Name/Tower Lot/Block/Phase/House No. Street Name Subdivision/Village/Zone

Barangay Town/District Municipality/City Province ZIP Code

Part V – Tax Type

39 Tax Types (this portion determines your tax liability/ies) (To be filled up by BIR)
Form Type ATC Form Type ATC
Withholding Tax Registration Fee

Compensation Percentage Tax

Expanded Stocks
Overseas Dispatch And
Final Amusement Taxes

Fringe Benefits Under Special Laws

VAT & Other Percentage
Percentage Tax Other Percentage Tax under NIRC (specify)
ONETT not subject to
CGT
Percentage Tax on
Winnings & Prizes Documentary Stamp Tax
On Interest Paid On Deposits And
Yield on Deposits/Substitutes Regular
One-Time Transactions
Income Tax (ONETT)
Capital Gains – Real
Excise Tax Property

Alcohol Products Capital Gains – Stocks

Automobile & Non-
Essential Goods Donor’s Tax

Cosmetics Procedures Estate Tax

Mineral Products Miscellaneous Tax (specify)

Petroleum Products

Sweetened Beverages Others (specify)

Tobacco Products

Tobacco Inspection Fees

 Page 3 – BIR Form No. 1901
Part VI – Authority to Print
40 Authority to Print Receipts and Invoices
40A Printer’s Name IPRINT SERVICES 40B Printer’s TIN 234 - 567 - 890 - 0000
40C Printers Accreditation Number 1234567 40D Date of Accreditation (MM/DD/YYYY) 02 15 2020
40E Registered Address
Unit/Room/Floor/Building# Building Name/Tower Lot/Block/Phase/House No. Street Name Subdivision/Village/Zone

2F COMPLEX
Barangay Town/District Municipality/City Province ZIP Code

PANDI BULACAN 3014

40F Contact Number 09953321095 40G E-mail Address [email protected]
40H Manner of Receipt/Invoices Bound Loose Leaf Others
40I Descriptions of Receipts and Invoices (Additional Sheet/s if Necessary)
NO. OF NO. OF NO. OF
TYPE BOXES/BOOKLETS SETS PER COPIES
SERIAL NO.
Description BOX /
VAT NON-VAT LOOSE BOUND PER SET START END
BOOKLET

Part VII - For Employee with Two or More Employees (Multiple Employments) Within the Calendar Year
Successive employments (With previous Concurrent employments (With two or more employers at the same time
41 Type of Multiple Employments employer/s within the calendar year) with the calendar year)
(If successive, enter previous employer/s; if concurrent,Center secondary employer/s) C
i Previous and Concurrent Employments During the Calendar
i Year
41A Name of Employer v v 41B TIN of Employer
i i
l l - - -
41C Name of Employer 41D TIN of Employer
- - -
42 Declaration
I declare, under the penalties of perjury, that this application has been made in good faith, verified by me and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National
Internal Revenue Code, as amended, and the regulations issued under the authority thereof. Further, I give my consent to the processing of my information as contemplated under the *Data Privacy Act of 2012 (R.A.
No. 10173) for legitimate and lawful purposes.

___________________________
Taxpayer/Authorized Representative
(Signature over Printed Name)
Part VIII – Primary/Current Employer Information
Branch
43 Type of Registered Office Head Office
Office 44 TIN - - - 45 RDO Code
C
46 Employer Name If Individual (Last Name) C (First Name) (Middle Name) (Suffix)
i i
v v
If Non-Individual i
(Registered Name)
i
l l

47 Employer Address
Unit/Room/Floor/Building# Building Name/Tower Lot/Block/Phase/House No. Street Name Subdivision/Village/Zone

Barangay Town/District Municipality/City Province ZIP Code

48 Contact Details
Landline Number Fax Number Mobile Number Email Address (required)

49 Relationship Start Date (MM/DD/YYYY) 50 Municipality Code (To be filled up by BIR)

51 Declaration Stamp of BIR Receiving Office
I declare, under the penalties of perjury, that this application has been made in good faith, verified by me and to the best of my knowledge and belief, is true and and Date of Receipt
correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, I give my consent
to the processing of my information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

FAYE DIANNE D MENDOZA

_____________________________________________
OWNER
________________________
EMPLOYER/AUTHORIZED REPRESENTATIVE Title/Position of Signatory
(Signature over Printed Name)
Part IX – Payment Details
52 For the Year 2021 53 Date of Payment (MM/DD/YYYY) 02 15 2021 54 ATC MC180
55 Tax Type RF 56 Manner of Payment REGISTRATION FEE 57 Type of Payment FULL PAYMENT
58 Registration Fee 58A 500.00
59 BIR Printed Receipts / Invoices 59A
60 Add: Penalties Surcharge Interest Compromise
60A 60B 60C 60D

61 Total Amount Payable (Sum of Items 58A, 59A and 60D) 500.00
*NOTE: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)
Documentary Requirements:

1. Any identification issued by an authorized government body (e.g. Birth Certificate, passport, driver’s license, Community Tax Certificate) that
shows the name, address and birthdate of the applicant;
2. Photocopy of Mayor’s Business Permit; or Duly received Application for Mayor’s Business Permit, if the former is still in process with the LGU;
and/or Professional Tax Receipt/Occupational Tax Receipt issued by the LGU;
3. Proof of Payment of Registration Fee (RF) (if with existing TIN or applicable after TIN issuance);
4. BIR Form No. 1906; (Select an Accredited Printer)
5. Final & clear sample of Principal Receipts/ Invoices;
Additional documents, if applicable:
a. Special Power of Attorney (SPA) and ID of authorized person, in case of authorized representative who will transact with the Bureau;
b. Franchise Documents (e.g. Certificate of Public Convenience) (for Common Carrier);
c. Photocopy of the Trust Agreement (for Trusts);
d. Photocopy of the Death Certificate of the deceased (for Estate under judicial settlement);
e. Certificate of Authority, if Barangay Micro Business Enterprises (BMBE) registered entity;
f. Proof of Registration/Permit to Operate BOI/BOIARMM, PEZA, BCDA and SBMA
6. In case of registration of branches/facility types:
a. Photocopy of Mayor’s Business Permit; or Duly received Application for Mayor’s Business Permit, if the former is still in process with the
LGU; and/or Professional Tax Receipt/Occupational Tax Receipt issued by the LGU;
or DTI Certificate;
b. Special Power of Attorney (SPA) and ID of authorized person, in case of authorized representative who will transact with the Bureau; if
applicable
c. Proof of Payment of Registration Fee (RF)
d. BIR Form No. 1906; (Select an Accredited Printer)
e. Final & clear sample of Principal Receipts/ Invoices;

POSSESSION OF MORE THAN ONE TAXPAYER INDENTIFICATION NUMBER (TIN) IS CRIMINALLY PUNISHABLE PURSUANT TO THE
PROVISIONS OF THE NATIONAL INTERNAL REVENUE CODE OF 1997, AS AMENDED