Annex B

REPUBLIKA NG PILIPINAS
KAGAWARAN NG PANANALAPI
KAWANIHAN NG RENTAS INTERNAS
REVENUE REGION NO.
REVENUE DISTRICT NO.








TAXPAYER DETAILS
TIN



NAME
BUSINESS/TRADE NAME


REGISTERED ADDRESS




PRINTER DETAILS
TIN NAME



REGISTERED ADDRESS



DESCRIPTION OF RECEIPTS/INVOICES
DESCRIPTION TYPE
No. of Booklets
No. of Sets
Per Booklet
No. of Copies
Per Set
Serial Nos.
Loose Bound From To










Date of ATP:

Valid Until:

Printers Accreditation No.:
REVENUE DISTRICT OFFICER
Date of Accreditation: of the Issuing Office (RDO)

IMPORTANT: Please address any communication on this matter to___________________________________________________
at telephone no(s)._____________________________________________________________

BIR
Form No.
Revised Sept 1999
1921
AUTHORI TY TO PRI NT
OCN________________