ANNEX B

REQUEST FOR CERTIFICATION ON THE STATUS OF CASES

PENDING LEGAL OR JUDICIAL RESOLUTION

________________________
(Date)
MEMORANDUM FOR:

________________________________________
(Head/Designation)
________________________________________
(Name of Issuing Legal Office)

In connection with the application for (specify the nature of the application (e.g., payment of tax refund,
bidding, utilization, revalidation and cash conversion of Tax Credit Certificates, etc .) of the taxpayer herein
below, this Office respectfully requests for the status of any case pending before your Office for legal or
judicial resolution.

Name of Taxpayer : _________________________________________________________

T.I.N. : _________________________________________________________
Address : _________________________________________________________

Your usual prompt action on this matter is highly appreciated.

____________________________________
(Head/Designation)
(Name of Requesting Office)
--------------------------------------------------------------------------------------------------------------------------------------------
(To be filled-up by the issuing legal office)

CERTIFICATION ON THE STATUS OF CASES PENDING LEGAL OR JUDICIAL RESOLUTION

This is to certify that the above-named taxpayer has the following record/s as of _________________:

1. For legal resolution by the issuing legal office

Tax Taxable
Assessment No. Amount Status
Type Period/Year

(Use Additional Sheet, If Necessary)

2. For Judicial resolution

Tax Taxable
Case No. Amount Status
Type Period/Year

(Use Additional Sheet, If Necessary)

Issued this ________ day of ____________________, 201___.

Note: This Certification shall be valid for only one (1) month.

________________________________________
(Head/Designation)
(Name of Issuing Legal Office)