DLN:

BIR Form No.

Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Part I
Application For Relief
From Double Taxation on 0901-C
Version 1.0 February 2010
Capital Gains
Date of Application
TAX TREATY INFORMATION
1.

2. Fill in all applicable spaces. Mark all appropriate boxes with "NOT APPLICABLE" if no appropriate response.
2A Philippines Tax Convention with _______________________________ .
2B Article Invoked
Part II PAYMENT OF FEES
Processing and certification fees - AAB/BIR Official Receipt No. Date:
Part III PARTIES
1 Seller: (Attach separate sheet with the required information if there are two or more sellers)
Name: TIN:
Type of Entity: Corporation Partnership Individual Other:
(specify)
Is seller the Head
Office or a branch? Head Office Branch (if Branch, state country where Branch is registered) ________________
Address:
Business Phone No.: Fax No.: e-mail Address:
Date of Issuance of SEC Certification of Non-Registration of Corporation/Partnership:
(attach original copy)
Country of Incorporation / Residence:
2 Buyer:
Name: TIN:
Address:
B i
Business Phone
Ph No.:
N Fax No.: e-mail Address:

3 Agent in the Philippines of: Seller Buyer Both

Name: TIN:
Address:
Business Phone No.: Fax No.: e-mail Address:

Part IV DETAILS OF TRANSACTION

Philippine Corporation whose shares of stock are subject of sale/transfer:

S.E.C. Certificate No. Date Issued:

Date of sale/transfer
Total number of unit of participation/shares sold/transferred
Shares of stock Traded in the Stock Exchange Par Value Per Share (for Par shares)
Shares of stock Not Traded in the Stock Exchange Issue Value per Share (for No-Par shares)
Unit in Partnership
Real Property Interest (RPI), if applicable, of the Philippine Corporation as appearing in its audited financial statement
as of the date of sale/transfer of shares of stock/unit of participation (Use formula below)
Interest on properties enumerated in Sec. 3 of RR 4-86 (as
Real Property Interest (RPI) = reflected in Part V) %
Entire assets in terms of value
*Sale or transfer of shares of stock in Philippine Corporation includes sale or transfer of unit of participation in a Philippine Partnership.

Part V PERJURY DECLARATION

I/We declare, under the penalties of perjury, that this application has been made in good faith, and
that the representations incuding the accompanying documents have been verified by me/us and to the Stamp of BIR Receiving Office
best of my/our knowledge, belief, and information are correct, complete and true account of the and Date of Receipt
transaction/s subject of this application.
Seller/Agent of Seller and/or Buyer SIGNATURE

ITAD Filing Reference No.:

Part VI DOCUMENTARY REQUIREMENTS REMARKS
GENERAL DOCUMENTS
1. Proof of Residency
Original copy of consularized certification issued by the tax authority of the country of the income earner to the effect that such income earner is a
resident of such country for purposes of the tax treaty being invoked in the tax year concerned.
2. Articles of Incorporation (For income earner other than an individual)
Photocopy of the Articles of Incorporation (AOI) (or equivalent Fact of Establishment/Creation /Organization) of the income earner with the
original copy of consularized certification from the issuing agency, office or authority that the copy of Articles of Incorporation (AOI) (or
equivalent Fact of Establishment/Creation /Organization) is a faithful reproduction or photocopy.
3. Special Power of Attorney
A. If applicant/filer is the withholding agent of the income earner or the local representative in the Philippines of the income earner -
i. Original copy of a consularized Special Power of Attorney (SPA) or a consularized written authorization duly executed by the income earner
authorizing its withholding agent or local representative in the Philippines to file tax treaty relief application.
B. If applicant/filer is the local representative of the withholding agent of the income earner -
i. Original copy of a consularized Special Power of Attorney (SPA) or a consularized written authorization duly executed by the income earner
authorizing its withholding agent or local representative in the Philippines to file tax treaty relief application; and
ii. Original copy of Letter of Authorization from the withholding agent authorizing local representative to file the tax treaty relief application
4. Certificate of Business Presence in the Philippines.
a. For Corporation or Partnership - Original copy of certification from the Philippines Securities and Exchange Commission that income
recipient is/is not registered to engage in business in the Philippines
b. For Individual - Original copy of a certification from the Department of Trade and Industry that the income earner is not registered to engage
in business in the Philippines
5. Certificate of No Pending Case
Original copy of a sworn statement providing information on whether the issue(s) or transaction involving directly or indirectly the same
taxpayer(s) which is/are the subject of the request for ruling is/are under investigation; covered by an on-going audit, administrative protest, claim
for refund or issuance of tax credit certificate, collection proceedings, or subject of a judicial appeal
ADDITIONAL DOCUMENTS SPECIFIC TO CAPITAL GAINS TAX FOR STRAIGHT SALE OR TRANSFER TRANSACTIONS
1. Contract
Original or certified copy of the notarized Deed of Absolute Sale or notarized Deed or Contract e.g. Deed of Assignment, which actually
transfers the ownership of the subject shares of stock
2. Stock Certificates
Certified copy of the Stock Certificate/s or Subscription Contract covering the subject shares of stock
3. General Information Sheet
Certified copy of the General Information Sheet (GIS) filed with the SEC, showing the name of the subscriber (when shares are not yet fully
paid and as a consequence, stock certificates have not been issued).
4. Corporate Secretary Certificates
Original copy of the duly notarized certificate executed by the Corporate Secretary of the domestic corporation showing the following information:
i. number and value off the subject
j shares off the seller as off the date off sale;;
ii. seller's percentage of ownership as of the date of sale;
iii. acquisition date(s) of the subject shares;
iv. mode of acquisition of the subject shares, including details of previous transfers and the actual Deed showing the parties involved in said
transfers; and
v. buyer's percentage of ownership after the transfer of the subject shares.
5. Comparative Schedule of Property, Plant and Equipment
Original copy of the comparative schedule duly certified by a responsible officer of the Philippine corporation, of the “real property or real
property interest/s” of the domestic corporation, reflecting the necessary adjustment for the period from the last audited financial statement to
the date of the interim unaudited financial statement submitted under no. 12, using the format and observing the guidelines set forth in Part VII
of the BIR Form No. 0901-C.
6. Financial Statement
a. Certified copy of the audited financial statements* for the year prior to the sale or transfer of the subject shares of stock; and
b. Original copy of the unaudited/or interim financial statements as of a specific date nearest to the date of sale, signed by a responsible officer
of the Philippine corporation.
7. BIR Form No. 0605- Payment Form
Certified copy of BIR Form No. 0605 and the official receipt reflecting the payment of the processing and certification fee with an authorized
agent bank under the jurisdiction of Revenue District Office No. 39, together with bank receipt or deposit slips.
8. BIR Form No. 2000 - Documentary Stamp Tax

Certified copy of BIR Form No. 2000 and the official receipt reflecting the payment of the documentary stamp tax on the subject sale or
transfer of the shares of stocks. If the documentary stamp tax shall be borne by the nonresident seller and/or nonresident buyer, the tax shall be
paid and the return shall be filed with an authorized agent bank under the jurisdiction of Revenue District Office No. 39. In case the buyer is a
resident of the Philippines, the return shall be filed and the tax shall be paid in accordance with Section 200(C) of the National Internal Revenue
Code of 1997.
Part VII COMPARATIVE SCHEDULE OF PROPERTY, PLANT & EQUIPMENT (PPE)
Previous Year Current Year Transaction Date
Accumulated Depreciation Total Accumulated Total Accumulated
Particulars Acquisition Cost Book Value Book Value Depreciation Expense Book Value
Depreciation Expense Depreciation Depreciation

PPE1 xxx xxx xxx xxx xxx xxx xxx xxx xxx

PPE2 xxx xxx xxx xxx xxx xxx xxx xxx xxx

PPE3 xxx xxx xxx xxx xxx xxx xxx xxx xxx

Totals xxx xxx xxx xxx xxx xxx xxx xxx xxx

*Financial Statements refer to the balance sheet, income statement, cash flow statement, statement showing changes in equity, statement of retained earnings, and notes thereto

BIR FORM NO. 0901-C

Guidelines and Instructions
This form shall be duly accomplished in (3) three copies which must be signed by the applicant who may either be the income earner or the duly authorized representative of the income earner.
All fields must be mandatorily filled-up. If "NOT APPLICABLE" or "NONE" is/are the appropriate response, the same has/have to be clearly indicated in the corresponding field.
This form together with all the necesary documents mentioned in Part VI shall be submitted only to and received by the International Tax Affairs Division of the Bureau of Internal Revenue on
or before
b f fif
fifth
h (5) dday off the
h ffollowing
ll i monthh ffrom the
h ddate when
h the
h D
Deed
d off Ab
Absolute
l S Sale/Contract
l /C was executedd
Failure to properly file the TTRA with ITAD within the period prescribed herein shall have the effect of disqualifying the TTRA under this RMO.