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II
iT
PSOC:
PSIC:
Republlka ng Plilpinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
- Apr
2016
PART I
4
7
TIN
Yes
No. of
sheets attached
No
jo
Background Information
770
183
RDO
Code
433
6 Line of
Buenesx
074
Taxpayer's Name (Last Name, First Name, Middle Name for Individuals) I (Registered Name for Non-Individual)
2550-M
4412068
10
Telephone Number
Zip Code
5001
Yes
PART II
' No
Computation of Tax
Sales/Receipts for the Month
(Exclusive of VAT)
12
12A
13
Sales to Government
13A
14
14
15
Exempt Sales/Receipts
15
16A
116054.34
12B
13.926,52
0.00
13B
0.00
16B
13,926.52
17A
0.00
17B
0.00
0.00
-
0.00
116,054,34
17B
Input Tax Carried Over from Previous Period / Excess over 70% of Output VAT to Input Tax Carried Over from
Previous Period
Input Tax Deferred on Capital Goods Exceeding P1 Million from Previous Period
17C
17C
17D
17D
17E
Others
17E
["'"
0.00
17F
17F
0.00
17A
18 Current Transactions
0.00
Purchases
I 8A/B
18A
I 8C/D
18C
18E/F
18E
0.00
18F
I 8G/H
18G
0.00
18H
181/i
181
0.00
181
I 8K/L
18K
0_
18- L
18M
IBM
0.00
18N!0
Others
18N
107,304.33
Total Current Purchases (Sum of Item 18A, 18C, 18E, 180, 181,
18K. IBM & 18N)
18P
107,304.33
19 Total Available Input Tax (Sum of Item 17F, 18B, 18D, 18F, 18Ff, 1$J, 18L &
r-
0.00
18B
0.00
18D
180)
0.00
0.00
0.00
0.00
0.00
--
0.00
180
12,876,52
19
12,876.52
21
20A
20B
20B
20C
20C
0.00
20D
20D
0.00
20E
Others
20E
20F
20F
:-
20A
21
0.00
1
0.00
0.00
--
0.00
12,876.52
23A
23B
r
r
r
0.00
23C
23D
23D
0.00
23E
Others
23E
0.00
23F
Total Tax Credits/Payment (Sum of Item 23A. 23B. 23C, 23D & 23E)
23F
23B
230
25A
Interest
25B
0,00
0.00
1,050.00
24
Surcharge
0.00
Compromise
25C j
0.00
0.00 25D
26
0.00
1050.00
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Republika ng Pilipinas
Kagawaran ng Panartalapi
Kawanihan ng Rentas Internas
:163353696
Date
:1,050.00
Bank
Origin
Bank
Code
Amount
Online Confirmation
Batch Confirmation
Batch Acknowledgment
086000
086000
086000
1,050.00
1,050.00
1,050.00
05/23/2016
086000
LBP
Number
Date
00052320161418022930 05123/2016
CN0523201 61418022930 05/23/2016
AN052320161418022930 05/23/2016
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