Republic of the Philippines

ANNEX “A”
DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE

This is to certify that _____________________________________________________

of ___________________________________________________________________________

with Taxpayer Identification Number ______________________ has availed the provisions

of _______________________________________, and the application/s for the compromise

settlement of deficiency ______________________________________________________

tax/es amounting to ____________________________________________________________

(P_____________________) under Assessment No/s. _________________________________

dated ______________________ covering taxable year/period ______________ has/have

been approved by the _______________________________________________________.

Issued this __________ day of __________________________, ________

Commissioner of Internal Revenue

By:

CAC 2017 00000000