PSOC: PSIC: 5138 Guidelines and Instructions | Help Republika ng Pilipinas Kagawaran ng Pananalapi Kawanihan ng Rentas Internas Payment Form BIR Form No. 0605 September 2003(ENCS) 1 For the Calendar Fiscal 3 Quarter Clear Quarter 4 Due Date (MM/DD/YYYY) 5 No. of Sheets Attached 6 ATC 2 Year Ended (MM/YYYY) 12 December 2015 1st 2nd 3rd 4th 0 MC210 7 Return Period (MM/DD/YYYY) 03 04 2015 8 Tax Type Code MC Part I Background Information 9 Taxpayer Identification No. 10 RDO Code 11 Taxpayer Classification 12 Line of Business/Occupation 104 480 617 000 104 I N WHOLESALE OF MISCELLANEOUS CON 13 Taxpayer's Name(Last Name, First Name, Middle Name for Individuals)/(Registered Name for NonIndividuals) ROLDAN, AGNES RELAMPAGOS 14 Telephone Number 15 Registered Address PUROK 1 PATINAY AGUSAN DEL SUR 16 Zip Code 8500 17 Manner of Payment 18 Type of Payment Voluntary Payment Per Audit/Delinquent Account Installment No. of Installment Partial Payment Full Payment SelfAssessment Penalties Tax Deposit/Advance Payment Income Tax Second Installment(Individual) Others(Specify) Certification Fee Preliminary/Final Assess/Deficiency Tax Accounts Receivable/Delinquent Account Part II Computation of Tax 19 Basic Tax/Deposit/Advance Payment 19 100.00 20 Add Penalties Surcharge Interest Compromise 20A 0.00 20B 0.00 20C 0.00 20D 0.00 21 Total Amount Payable(Sum of Items 19 & 20D) 21 100.00 For Voluntary Payment Payment of Deficiency Taxes From Audit/Investigation Delinquent Accounts I declare, Under the penalties of perjury, that this document has been made in good faith, verified by me, and to the best of my 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. Preapproved by Investigating Office Not approved by Investigating Office Print Validate Edit Submit [ BIR Main | eFPS Login | User Menu | Guidelines and Instructions | Help ]

Roldan, A. --Certification__ BIR Form No

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PSOC: PSIC: 5138 GuidelinesandInstructions|Help

RepublikangPilipinasKagawaranngPananalapiKawanihanngRentasInternas PaymentForm

BIRFormNo.

0605September2003(ENCS)

1Forthe Calendar Fiscal 3QuarterClearQuarter 4DueDate(MM/DD/YYYY) 5No.ofSheetsAttached 6ATC

2YearEnded(MM/YYYY)

12December 2015 1st 2nd 3rd 4th 0 MC210

7ReturnPeriod(MM/DD/YYYY) 03 04 2015 8TaxTypeCodeMC

PartI BackgroundInformation

9TaxpayerIdentificationNo. 10RDOCode 11TaxpayerClassification 12LineofBusiness/Occupation

104 480 617 000 104 I N WHOLESALEOFMISCELLANEOUSCONSUMERGOODS

13Taxpayer'sName(LastName,FirstName,MiddleNameforIndividuals)/(RegisteredNameforNonIndividuals)ROLDAN,AGNESRELAMPAGOS

14TelephoneNumber

15RegisteredAddressPUROK1PATINAYAGUSANDELSUR

16ZipCode8500

17MannerofPayment 18TypeofPayment

VoluntaryPayment PerAudit/DelinquentAccount

Installment

No.ofInstallment

PartialPaymentFullPayment

SelfAssessmentPenaltiesTaxDeposit/AdvancePaymentIncomeTaxSecondInstallment(Individual)Others(Specify)

CertificationFee

Preliminary/FinalAssess/DeficiencyTax

AccountsReceivable/DelinquentAccount

PartII ComputationofTax

19BasicTax/Deposit/AdvancePayment 19 100.00

20AddPenalties

Surcharge Interest Compromise

20A 0.00 20B 0.00 20C 0.00 20D 0.00

21TotalAmountPayable(SumofItems19&20D) 21 100.00

ForVoluntaryPaymentPaymentofDeficiencyTaxes

FromAudit/InvestigationDelinquentAccounts

I declare, Under the penalties of perjury, that this document hasbeen made in good faith, verified by me, and to the best of myknowledgeandbelief,istrueandcorrect,pursuanttotheprovisionsof the National Internal Revenue Code, as amended, and theregulationsissuedunderauthoritythereof.

PreapprovedbyInvestigatingOfficeNotapprovedbyInvestigatingOffice

Print Validate Edit Submit

[BIRMain|eFPSLogin|UserMenu|GuidelinesandInstructions|Help]