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Part II Details of Income Payment and Tax Withheld (Attach additional sheet if necessary)
Nature of Income Payment ATC Amount of Payment Tax Withheld
Purchase of Service 1,350.00 60.26
Total 60.26
We declare, under the penalties of perjury, that this certificate 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 the regulations issued under authority thereof.
YOLANDA L. VALDIZNO 124-131-389-000 Head Teacher I
Payor/Payor's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
CONFORME:
Payee/Payee's Authorized Representative/Accredited Tax Agent TIN of Signatory Title/Position of Signatory Date Signed
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Date of Issuance Date of Expiry
To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)
I declare, under the penalties of perjury, that the information I declare under the penalties of perjury that I am qualified under substituted filing of Percentage
herein stated are reported under BIR Form No. 1600 which Tax/Value Added Tax Returns (BIR Form 2551M/2550M/Q), since I have only one payor from
have been filed with the Bureau of Internal Revenue. whom I earn my income; that, in accordance with RR 14-2003, I have availed of the Optional
Registration under the 3% Final Percentage Tax Wthholding/10% Final VAT Withholding in lieu
of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges accorded by the
Substituted Percentage Tax Return/Substituted VAT Return System prescribed in the aforesaid
Payor/Payor's Authorized Representative/Accredited Tax Agent Regulations; that, this Declaration is sufficient authority of the withholding agent to withhold 3%
Signature Over Printed Name Final Percentage Tax/10% Final VAT from my sale of goods and/or services.
TIN of Signatory Title/Position of Signatory Payee/Payee's Authorized Representative/Accredited Tax Agent Title/Position of Signatory
Signature Over Printed Name
Tax Agent Accreditation No./Attorney's Roll No. (if applicable) Tax Agent Accreditation No./Attorney's Roll No. (if applicable) TIN of Signatory
6 Payee's Name (Last Name, First Name, Middle Name) For Individuals
8 Registered Address
10 Foreign Address
Part II
Nature of Income Payment
Purchase of services - 5%
Total
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by us, and to the best of our knowledge and belie
correct pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
LEOPOLDO A. IGNAC
Payor/Payor's Authorized Repre
Signature Over Printed Na
CONFORME:
13
Payor/Payor's Authorized Representative
Signature Over Printed Name
Legend:
NRAETB = Non-resident Alien Engaged in Trade or Business
NRANETB = Non-resident Alien Not Engaged in Trade or Business
SBMA = Subic Bay Metropolitan Authority
(MM/DD/YY)
Income Recipient/Payee Information
8A Zip
Code
10A Zip Code
WV-020
ative
7 Payor's Name (Last Name, First Name, Middle Name) For Individuals
9 Registered Address
3,549.63 158.47
Date Signed
Date Signed
(substituted filing)
the penalties of perjury that I am qualified under substituted filing of Percentage
BIR Form 2551M/2550M/Q), since I have only one payor from
n accordance with RR 14-2003, I have availed of the Optional
Percentage Tax Wthholding/10% Final VAT Withholding in lieu
VAT in order to be entitled to the privileges accorded by the
turn/Substituted VAT Return System prescribed in the aforesaid
on is sufficient authority of the withholding agent to withhold 3%
l VAT from my sale of goods and/or services.
14
Payee/Payee's Authorized Representative
Signature Over Printed Name
Tax Withheld
158.47
tative
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Certificate of Creditable Tax
Withheld At Source
1 For the Period
3 06 6
32 20 4 5 20
From 2 (MM/DD/YY) To 0 (MM/DD/YY)
Part I Payee Information
2 Taxpayer
006 895 049 000
Identification Number
3 Payee's Name CONVERGE ICT SOLUTIONS INC
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
4 Registered Address
5 Foreign Address
Payor Information
6 Taxpayer
Identification Number
0 0 0 8 6 3 9 5 8 1 4 2
7 Payor's Name Dep Ed Bulacan-Division Office ( Dagat-Dagatan Elementary School) San Rafael, Bulacan
(Last Name, First Name, Middle Name for Individuals) (Registered Name for Non-Individuals)
8 Registered Address
Malolos City
PART II Details of Monthly Income Payments and Tax Withheld for the Quarter
Income Payments Subject to AMOUNT OF INCOME PAYMENTS
ATC
Expanded Withholding Tax 1st Month of 2nd Month of 3rd Month of Total
the Quarter the Quarter the Quarter
Total
Money Payments Subject to Withholding
of Business Tax (Government & Private)
Conforme:
Payee/Payee's Authorized Representative Date Signed
Signature Over Printed Name
BIR Form No.
2307
March 2003 (ENCS)
me for Non-Individuals)
4A Zip Code
5A Zip Code
afael, Bulacan
me for Non-Individuals)
8A Zip Code
uarter
24.10
2925.67 24.10
y knowledge and belief, is true and correct,
Head Teacher I
Title/Position of Signatory
Date Signed