Background Information: Yes No 0 2 1 2
Background Information: Yes No 0 2 1 2
Background Information: Yes No 0 2 1 2
7. Withholding Agent's name(Last Name,First Name for Individuals)/(Registered Name for Non-Individuals ) 8 Telephone No
ABC Corporation Ltd., Philippines 123131
11 Incase of over withholding/overremittance after the year-end adjustment on compensation If yes specify
have you released the fund to your employees ¨ Yes ý No Date of Refund
FEB 1787.24
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
TOTAL 7248.97
Schedule-II Remittance per BIR Form No 1601 -F
JAN 0.00
FEB 229.76
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
TOTAL 229.76
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
TOTAL
Schedule-IV Remittance per BIR Form No 1603
DATE OF NAME OF TAXES
Quarter REMITTANCE BANK/BANK CODE/
ADJUSTMENT PENALTIES TOTAL AMOUNT REMITTED
WITHHELD
ROR NO.IF ANY
TOTAL
We declare, under the penalities of perjury, that this declaration 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
S. Scott
Stamp of receiving Office
15 President/vice president/ Principal Officer/Accredited Tax Agent/ 16 Treasurer/Assistant Treasurer
Date of Receipt
Authorised Representative/Taxpayer (Signature Over Printed Name)
(Signature Over Printed Name)
Tax Agent Acc.no/Atty's Roll No.(if appli Date of issuance Date of expiry Title/Position of Signatory