To be filied

Application for
Registration

,. '.--1.99?-,
Oo be fiiled up by BIR)

Oo be filed up by BIR)

TIN
(For Tapayer M existing

-with

qualified dependent

child/ren l-lwithout

qualifled dependent child/ren

exceed P250,000 per annum

for Additional ExemptionsiPremium Deductions for husband and wife-lghose aggregate family income does not
17
" > Claims
ional exemption and any premium deduction I-l \Mle clairns additional exemption and any premium deduction
n trrrn.no
"i-ir. "oai
(Attach Waiver
waiver of Husband)
18 Spouse lnformation

18D

llliliti
9

Spouse EmPloyer's

Name
I

childchieflydependentupon&livingwiththetaxpayer;not

Names of Qualified Dependent

more than 21 years ol age. unmarried, and not gainfully employed; or regardless of age, is incapable of self-

198

208
21FJ

22C

228

E
E

Successive employments (With previous employer(s) within the caiendar year)

Concurrent employments (With two or more employers at the same time within the calendar year)

to the best of nry knowledge arfilletiet,

rulations issued under author8"tt*eof.

I declare, under the penalties of periury, that

of the ry.,

,"--- - -

irue and correct, pursuant to the provisions

*vrfl

.:

IN

7il

totc 4+k

?krt* QvDW ffit

Dd,

(Date of Cerlifition of the Accuracy of the

>
Oo be tilled
up by the BIR)
(MM/ DD/

I declare, under the

me and to the best of m'i
National lnternal

rrYY)

lrjury, that this form has been made in good faith, verified by
belief, is true and corred, pursuant to the provislons of the
and the regulations issued under authority thereof

(MM/

DD/YYYf)

and Date of Receipl

Certifi cate of Compensation

Rep$dika ng Pilipinas
Kagawaran ng Pananalapi

PaymenUTax Withheld

Kauranihan ng Rentas lnternas

2008 (ENCS)

\Mth or WithoutTax Withheld

For Compensation

2316

M-B

Oets*i of Compnsadon lmollG rnd Trr urlttheld from Presnt

I{ON.TAXABLE'EXEilIPT COTPEilSATION IXCOiIE

Emoloyeek Na@ILast Name. Filst Name, Middle

Name)

12

Basic Salary/

Strtutory Minimum Wage

Minimum Wagre Einnei (MWE)

ls the wifu cldiming the addilional

e:mp@

qualified dependent children?

{'l

Holiday Pay fitrYE)

33

Overtime Fay (MWE)

34

Night Shifi. Differenual (Mvr/E)

35

Hazard Pay $rudE)

36

l3th Month Pay

and Other Benefits

17

De Minimis Benefits

38

SSS, GSIS, PHIC &

Pag-ibig 39

DEteof Birth{MM/DDIYYYn

Confibuiions, & Union Dueg

(Employee share ody)

Salaries & Otler Forms

Compnsation
StatutoryMinirrum Wa0e rate per

l-l

l-......-J

month I

of

40

TolalNon-Tgr(ablelExempt

11

Compensation lncome
Minimum Wage Eamer whose compensation is exempt from
rr*Ll^rri-

- .^.,

i^.

^r)

.^

^..L:^J

!-^--^

.^r,

TAXABLE COiIPE}r.SAflO N
REGULAR

lllcoiilE
12

Basic Salary

13

Repre$entration

44

Transportation
Gostof Living
Fixed Housing

{4

Alharance

{5

lUlowancr {6

Others(Specry)

Commission
Profit Shafog

Fees lnc[dino Dl'rcc.to/s

Fees

Less: Premium Paid on

60

Taxable 13th Monlh Pay

and Other.,Bensfb

5'

Hazard Pav

52

28

OvertimePay

5:t

zlt

Others

l-lealth n

eftUor HospfrEl l6s{d'{nc6 (lt alplicabh)

NetTaxable
Tax Due

Comoensaflon lncome

(Specin

Amount of Taxea Wihheld

304 Present Employer

308 Previgus Employel

3l

TotalAmoqntsfTaxos Wthheld 3l

TotalTableCornpensafion 55
Revenu Code, as amended, and lhe regulations issued under authority tiereof.

SS NUMBER

SOCHSFURITY

j 't " 'i ',.

"'

;,., i

SYSTEM

E-1

PERSONAI. RECORT)

' ,i'''i

(Please Use Black lnk Only)

(Gumamit ng ltim na Tinta Lamang)

GIVEN NAME

(Rev. 08/94)

MTDDLE NAMEr6/iNANG

IPANGAL/NJ

PANGAT AN)

,"'Ii',-i-.1
ADDRESS (No. & STREET; CITYiToWN & PROVINCE)

sEx

KALqE, LUNGSOD/BAqAN AT UUWIGAN)

r-'l
L-)

FEIIVIALE
FABAE)

cML

mmd-dyy

LJ

DATE OF BTRTH

MOTHER

MARRIED T--'I
IMAYASAWA,

L-l

WIOOWED
BALOI

0NA,)

i", r

&APANGANAKAN)

F
lJ

ii ,'' ; i i-: ':

FATHER(AMA)
,':,. \. ,,. i i-.3. ;r,i:-!,..;' i .:i. l.: 1.,, i.-_.,- i' ..

i*:. i i i:'.' \ (--ii-;,.;'t:'-:, l l,i.l- --, i i,.i.,ll-:etl \

rWAt,4/vGdSIL!4i

ES (MA"K,KINAB'ANc)

sPousErASAWA)

CHILDREN
(MGAANAK)

| :l;1.'

STATUS rM IA yUANG S/Btt)

T-'I SINGLE

B E N E F I G lARl

POSTALCODE

DATE OF B|RTH rKl PANGANAMN)

fMSARIAN.)

In-l MALE
l!) LALAKT)

IRAH/&:

B1_ANG AT

( E WrHd,rT SrcUSE Cl-fii AR PARENT)

(IBANG MAKII<INABANG..KUNG WALANG ASAWA. ANAK O MA9-UUNG)

oTHER BENEFICIAR,ES

'

SCq

utrtYi fiIl

PttYAT nt?rl$ell

2
6

4
5
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.THUMBMARK

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Ii-ii'j '',,.=r r'*.t,*-+-Ll

bv: ft?cfii-i

iiiiiei

(.Ako ay nagpapatunay na ang aking mga isinaad

information are true and correct.

ra

:
: ' .z'_;.;i .r-:.'
+-. -:
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e;

I hereby certify that the above

".s-

ay totoo at

tama.i)